MEDICARE: PAUL EUGENE SHIELDS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS010676L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	001370726	OTHER	PA	HIGHMARK BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508861949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL EUGENE SHIELDS DO

Provider Business Mailing Address
First Line	:	397 CHURCHILL HUBBARD RD
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-1375
Country	:	US
Telephone Number	:	330-759-6750
Fax Number	:	330-759-6755

Provider Business Practice Location Address
First Line	:	2501 W 12TH ST
Second Line	:	SUITE 1
City	:	ERIE
State	:	PA
Zip	:	16505-4527
Country	:	US
Telephone Number	:	814-806-1144
Fax Number	:	814-833-0659

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	10/10/2019

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Directions to “ PAUL EUGENE SHIELDS DO” Practice Location

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