Provider Demographics
NPI:1851461404
Name:SHIELDS, WILLIAM K (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:K
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 S ALDER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-4819
Mailing Address - Country:US
Mailing Address - Phone:253-272-9245
Mailing Address - Fax:253-272-9413
Practice Address - Street 1:2914 S ALDER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-4819
Practice Address - Country:US
Practice Address - Phone:253-272-9245
Practice Address - Fax:253-272-9413
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025898207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4078693OtherAETNA
WA1254972OtherFIRST HEALTH
WAAMIWAS326BOtherMOLINA
WA157762OtherLABOR & INDUSTRIES
WA1254972OtherCOVENRTY HEALTH CARE
WA3403351OtherCIGNA
WA1160159Medicaid
WA4078693OtherAETNA
WA3403351OtherCIGNA
WA157762OtherLABOR & INDUSTRIES