Healthcare Provider Details

I. General information

NPI: 1194848606
Provider Name (Legal Business Name): DR SCOTT L SHIELDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 N VAN BUREN
ENID OK
73703-4455
US

IV. Provider business mailing address

524 N VAN BUREN
ENID OK
73703-4455
US

V. Phone/Fax

Practice location:
  • Phone: 580-237-3338
  • Fax: 580-237-3399
Mailing address:
  • Phone: 580-237-3338
  • Fax: 580-237-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number189
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number189
License Number StateOK

VIII. Authorized Official

Name: DR. SCOTT LAMAR SHIELDS
Title or Position: PODIATRIST
Credential: DPM
Phone: 580-237-3338