Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | G45205 | CA |
NPI | 1033189634 |
---|---|
Provider Name | Dr. John Frederick Shield |
First Address | Sonora, CA 95370-8124 |
Second Address | Sonora, CA 95370-5289 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 22/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A49942 | (02) | CA |