Healthcare Provider Details

I. General information

NPI: 1821062449
Provider Name (Legal Business Name): BRIAN T SHIELDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 W 2ND PL
LAKEWOOD CO
80228-1527
US

IV. Provider business mailing address

PO BOX 5788
DENVER CO
80217-5788
US

V. Phone/Fax

Practice location:
  • Phone: 720-321-4161
  • Fax: 720-321-4165
Mailing address:
  • Phone: 303-903-6191
  • Fax: 303-202-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34182
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: