Healthcare Provider Details

I. General information

NPI: 1003201682
Provider Name (Legal Business Name): WILLIAM PAUL SHIELD III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13837 CIRCA CROSSING DR
LITHIA FL
33547-4382
US

IV. Provider business mailing address

PO BOX 850001 DEPT 8272
ORLANDO FL
32885-8272
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-2663
  • Fax: 813-658-6222
Mailing address:
  • Phone: 136-842-6638
  • Fax: 813-658-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberA167148
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME148179
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: