Provider Demographics
NPI:1508134313
Name:SHELBY PODIATRY
Entity Type:Organization
Organization Name:SHELBY PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRON
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARRUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:205-663-3224
Mailing Address - Street 1:227 A 1ST STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007
Mailing Address - Country:US
Mailing Address - Phone:205-663-3224
Mailing Address - Fax:205-663-3416
Practice Address - Street 1:227 1ST ST N
Practice Address - Street 2:STE A
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8767
Practice Address - Country:US
Practice Address - Phone:205-663-3224
Practice Address - Fax:205-663-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL154213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890020360Medicaid