Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | N-8292 | AR |
NPI | 1003896630 |
---|---|
Provider Name | Eddie W Shields |
First Address | Louisville, KY 40223-2992 |
Second Address | Little Rock, AR 72211-4375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 20/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
129121001 | (05) | AR |
A008 | CHAMPUS (01) | AR |
F99830 | (02) | AR |