Provider Demographics
NPI:1205832169
Name:OLDS, SHELBY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:
Last Name:OLDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 STEELES RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-9532
Mailing Address - Country:US
Mailing Address - Phone:423-844-6700
Mailing Address - Fax:423-844-6703
Practice Address - Street 1:350 STEELES RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-9532
Practice Address - Country:US
Practice Address - Phone:423-844-6700
Practice Address - Fax:423-844-6703
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD37267207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010098297Medicaid
VA145775OtherANTHEM
TN4088647OtherBCBS TN PROVIDER #
TNP00154678OtherRAILROAD MEDICARE
VA010098297Medicaid
TNP00154678OtherRAILROAD MEDICARE