Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 38487 | TN |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 38487 | TN |
NPI | 1003852831 |
---|---|
Provider Name | John D Shields |
First Address | Conshohocken, PA 19428-2439 |
Second Address | Clarksville, TN 37043-4990 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 24/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3893588 | (05) | TN |