Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | C29184 | CA |
NPI | 1245201938 |
---|---|
Provider Name | Dr. Clarence L Shields JR. |
First Address | Los Angeles, CA 90045-1543 |
Second Address | Los Angeles, CA 90045-1543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 27/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A33852 | (02) | CA |