Healthcare Provider Details

I. General information

NPI: 1700821790
Provider Name (Legal Business Name): SAM J. SHIELDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 GARCES HIGHWAY
DELANO CA
93215-3690
US

IV. Provider business mailing address

2550 NORTH HOLLYWOOD WAY SUITE 209
BURBANK CA
91505-5019
US

V. Phone/Fax

Practice location:
  • Phone: 661-721-5262
  • Fax: 661-721-5254
Mailing address:
  • Phone: 818-557-0135
  • Fax: 818-557-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC28997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: