Provider Demographics
NPI:1811968704
Name:SHELLANS, STEPHEN JR (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SHELLANS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2671 OSWELL ST # 312
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-3152
Mailing Address - Country:US
Mailing Address - Phone:661-634-3503
Mailing Address - Fax:
Practice Address - Street 1:420 34TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2237
Practice Address - Country:US
Practice Address - Phone:661-327-4647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16165207P00000X
CAG66984207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G669840Medicaid
OR930039808OtherRAILROAD MEDICARE
OR079231Medicaid
CA00G669847Medicare UPIN
OR079231Medicaid
CA00G669840Medicaid
ORR145854Medicare PIN