MEDICARE: DR. SHIELDS BREWSTER ABERNATHY M.D.

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	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	G42752	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	77-0049521	OTHER		FEIN NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508886235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIELDS BREWSTER ABERNATHY M.D.

Provider Business Mailing Address
First Line	:	1050 LAS TABLAS RD
Second Line	:	SUITE 3
City	:	TEMPLETON
State	:	CA
Zip	:	93465-9729
Country	:	US
Telephone Number	:	805-434-1000
Fax Number	:	805-434-3265

Provider Business Practice Location Address
First Line	:	1050 LAS TABLAS RD
Second Line	:	SUITE 3
City	:	TEMPLETON
State	:	CA
Zip	:	93465-9729
Country	:	US
Telephone Number	:	805-434-1000
Fax Number	:	805-434-3265

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	03/21/2017

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