Provider Demographics
NPI:1871578781
Name:SHELTON, ROBERT FRANKLIN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRANKLIN
Last Name:SHELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1005 MAR WALT DRIVE
Mailing Address - Street 2:PEDIATRIC DEPARTMENT
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547
Mailing Address - Country:US
Mailing Address - Phone:850-863-8203
Mailing Address - Fax:850-862-0977
Practice Address - Street 1:1005 MAR WALT DRIVE
Practice Address - Street 2:PEDIATRIC DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-863-8203
Practice Address - Fax:850-862-0977
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55015208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062670800Medicaid
FL10151OtherBCBSFL
FL10151ZMedicare PIN
E88420Medicare UPIN