Active NPI
Thomas N Shelton, D.O
- Family Medicine Physician
- Puyallup, WA
National Provider Identifier
1467457564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OP00001078
- Practice address
- 15214 Canyon Rd E Ste 120
Puyallup, WA 98375-7472 - Phone
- (253) 539-4200
- Fax
- (253) 539-6005
- NPI assigned
- Jun 15, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OP00001078 | WA | Primary |
Addresses
Primary practice location
15214 Canyon Rd E Ste 120
Puyallup, WA 98375-7472
Mailing address
15214 Canyon Rd E Ste 120
Puyallup, WA 98375-7472
Phone (253) 539-4200
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0263650 | Other | WA | STATE L&I |
| 911465840 | Other | WA | FEDERAL TAX ID |
| 0267959 | Other | WA | STATE L&I |
| 0263658 | Other | WA | STATE L&I |
| 0263633 | Other | WA | STATE L&I |
| 0263655 | Other | WA | STATE L&I |
| 0263636 | Other | WA | STATE L&I |
| 0263630 | Other | WA | STATE L&I |
| 0263632 | Other | WA | STATE L&I |
| 0263638 | Other | WA | STATE L&I |
| 0255578 | Other | WA | STATE L&I |
| 0263641 | Other | WA | STATE L&I |
| 0263642 | Other | WA | STATE L&I |
| 0268165 | Other | WA | STATE L&I |
| 5840SH | Other | WA | REGENCE BLUE SHIELD RIDER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302048000000",
"number": "1467457564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15214 CANYON RD E STE 120",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983757472",
"telephone_number": "253-539-4200",
"fax_number": "253-539-6005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15214 CANYON RD E STE 120",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983757472",
"telephone_number": "253-539-4200",
"fax_number": "253-539-6005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHELTON",
"first_name": "THOMAS",
"middle_name": "N",
"credential": "D.O",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-15",
"last_updated": "2011-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "OP00001078",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0263650",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL TAX ID",
"identifier": "911465840",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0267959",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0263658",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0263633",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0263655",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0263636",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0263630",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0263632",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0263638",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0255578",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0263641",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0263642",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0268165",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD RIDER",
"identifier": "5840SH",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Puyallup, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.