Healthcare Provider Details

I. General information

NPI: 1972666147
Provider Name (Legal Business Name): TED SHIELDS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TEDDY DOUGLAS SHIELDS D.O.

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 MAYFIELD DRIVE
JONESBORO AR
72401
US

IV. Provider business mailing address

108 N SHACKLEFORD RD
LITTLE ROCK AR
72211-2840
US

V. Phone/Fax

Practice location:
  • Phone: 844-215-0731
  • Fax: 888-630-8885
Mailing address:
  • Phone: 501-346-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberE3420
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberE3420
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberE3420
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: