Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 08804 | MS |
NPI | 1023074101 |
---|---|
Provider Name | John Garold Shields |
First Address | West Point, MS 39773-9342 |
Second Address | West Point, MS 39773-9342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 26/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00118146 | (05) | MS |
B30912 | (02) | MS |