Provider Demographics
NPI:1710965108
Name:HAMPTON, SHELBY L (MD)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:L
Last Name:HAMPTON
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 1:920 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3259
Mailing Address - Country:US
Mailing Address - Phone:281-882-8050
Mailing Address - Fax:281-882-2057
Practice Address - Street 1:920 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 400
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3259
Practice Address - Country:US
Practice Address - Phone:281-882-8050
Practice Address - Fax:281-882-2057
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1126174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181504501Medicaid
TX8L0481Medicare PIN
TXI43887Medicare UPIN
TX00Z486Medicare PIN