Provider Demographics
NPI:1679574131
Name:SHELTON, LAURA K (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:K
Last Name:SHELTON
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:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0012
Mailing Address - Country:US
Mailing Address - Phone:406-327-1918
Mailing Address - Fax:406-329-2937
Practice Address - Street 1:5549 OLD HWY 93
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MT
Practice Address - Zip Code:59833-6545
Practice Address - Country:US
Practice Address - Phone:406-273-4923
Practice Address - Fax:406-829-7874
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
011001675Medicare PIN
G59946Medicare UPIN