Provider Demographics
NPI:1093804486
Name:SHELTON, GARRETT (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:
Last Name:SHELTON
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:PO BOX 3494
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-3494
Mailing Address - Country:US
Mailing Address - Phone:580-233-5553
Mailing Address - Fax:
Practice Address - Street 1:3517 W OWEN K GARRIOTT RD
Practice Address - Street 2:SUITE FOUR
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-4952
Practice Address - Country:US
Practice Address - Phone:580-233-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100097080BMedicaid
OKH26715Medicare UPIN