Provider Demographics
NPI:1083871131
Name:SHELL, GRANTHAM MCALEER (MD)
Entity Type:Individual
Prefix:DR
First Name:GRANTHAM
Middle Name:MCALEER
Last Name:SHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 SPRING HILL AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-1410
Mailing Address - Country:US
Mailing Address - Phone:251-435-2663
Mailing Address - Fax:
Practice Address - Street 1:1720 SPRING HILL AVE FL 3
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1410
Practice Address - Country:US
Practice Address - Phone:251-435-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30197207XX0004X
ALMD.30197207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL160835Medicaid
102I203129Medicare PIN