MEDICARE: DR. MARK D SHIELDS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G77342	CA

General Provider Information

NPI Number	:	1366411555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK D SHIELDS MD

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	24221 CALLE DE LA LOUISA
Second Line	:	SUITE 200
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-7638
Country	:	US
Telephone Number	:	949-588-8700
Fax Number	:	949-465-8159

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	11/28/2025

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