MEDICARE: WILLIAM JENNINGS SHIELDS MD

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	207N00000X	Dermatology Physician	0101024156	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	002959	OTHER	VA	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992768253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JENNINGS SHIELDS MD

Provider Business Mailing Address
First Line	:	PO BOX 2696
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23609
Country	:	US
Telephone Number	:	757-874-0320
Fax Number	:	757-989-0276

Provider Business Practice Location Address
First Line	:	914 DENBIGH BLVD
Second Line	:
City	:	GRAFTON
State	:	VA
Zip	:	23692
Country	:	US
Telephone Number	:	757-874-0320
Fax Number	:	757-989-0276

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

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	07/08/2007

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