Provider Demographics
NPI:1982265161
Name:SHELTON, MATTHEW QUINN (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:QUINN
Last Name:SHELTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4305
Mailing Address - Country:US
Mailing Address - Phone:180-135-4822
Mailing Address - Fax:814-534-5599
Practice Address - Street 1:97 PROFESSIONAL WAY STE 2
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1680
Practice Address - Country:US
Practice Address - Phone:801-465-4896
Practice Address - Fax:018-465-4107
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT019600207Q00000X
UT12951971-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine