Provider Demographics
NPI:1295765808
Name:SHELTON, GEORGE ALLEN JR (PHD, MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:ALLEN
Last Name:SHELTON
Suffix:JR
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 W GRAY ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7117
Mailing Address - Country:US
Mailing Address - Phone:405-321-3499
Mailing Address - Fax:405-364-5379
Practice Address - Street 1:419 W GRAY ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7117
Practice Address - Country:US
Practice Address - Phone:405-321-3499
Practice Address - Fax:405-364-5379
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10835208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD35269Medicare UPIN