Healthcare Provider Details

I. General information

NPI: 1619954237
Provider Name (Legal Business Name): STEVEN E SHIELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18661 STATE HIGHWAY 120
GROVELAND CA
95321-9701
US

IV. Provider business mailing address

14400 JACKSONVILLE RD
JAMESTOWN CA
95327-9567
US

V. Phone/Fax

Practice location:
  • Phone: 209-962-7121
  • Fax: 209-962-0665
Mailing address:
  • Phone: 209-962-7121
  • Fax: 209-962-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCAG66861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: