Healthcare Provider Details

I. General information

NPI: 1396971255
Provider Name (Legal Business Name): MOLLY DUDLEY SHIELDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 WISEMAN BLVD SUITE # 215
SAN ANTONIO TX
78251-4417
US

IV. Provider business mailing address

1355 CENTRAL PKWY S STE 400
SAN ANTONIO TX
78232-5057
US

V. Phone/Fax

Practice location:
  • Phone: 210-675-6724
  • Fax: 210-675-1759
Mailing address:
  • Phone: 210-349-9300
  • Fax: 210-366-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberP6271
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: