Basic Information
Provider Information
NPI: 1801888334
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHELTON
FirstName: FRANK
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2401 DEMERS AVE
Address2:  
City: GRAND FORKS
State: ND
PostalCode: 58201
CountryCode: US
TelephoneNumber: 7017801891
FaxNumber: 7017801942
Practice Location
Address1: 1380 S COLUMBIA RD - ALTRU FAMILY MEDICINE CENTER
Address2:  
City: GRAND FORKS
State: ND
PostalCode: 58201
CountryCode: US
TelephoneNumber: 7017952000
FaxNumber: 7017801942
Other Information
ProviderEnumerationDate: 08/19/2005
LastUpdateDate: 03/01/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X10709NDY Allopathic & Osteopathic PhysiciansPediatrics 
208000000XMD044634EPAN Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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