Provider Demographics
NPI:1891717815
Name:SHIELDS, DOUGLAS A (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:A
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:JONAS RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28641-0098
Mailing Address - Country:US
Mailing Address - Phone:828-385-0915
Mailing Address - Fax:
Practice Address - Street 1:125 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-3035
Practice Address - Country:US
Practice Address - Phone:828-765-4201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNE4736207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00384358OtherMEDICARE RAILROAD
MO204445209Medicaid
WV5630460000Medicaid
VA010210364Medicaid
MS00125794Medicaid
TN3813512Medicaid
WVP0029524OtherMEDICARE RAILROAD
AR162345001Medicaid
TN3813511Medicaid
KY64338304Medicaid
KY50007474OtherPASSPORT HEALTH
ARP00378743OtherMEDICARE RAILROAD
KYP00384358OtherMEDICARE RAILROAD
TN3813512Medicaid
VA010210364Medicaid
TN3813511Medicaid
AR5N644Medicare PIN
TN3813512Medicare PIN
ARP00378743OtherMEDICARE RAILROAD
VA00W418S46Medicare PIN