Provider Demographics
NPI:1215038963
Name:SHIELDS, ANTHONY LEE JR (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LEE
Last Name:SHIELDS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2561 CITIPLACE CT
Mailing Address - Street 2:SUITE 750-118
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-2722
Mailing Address - Country:US
Mailing Address - Phone:225-202-2424
Mailing Address - Fax:
Practice Address - Street 1:2561 CITIPLACE COURT
Practice Address - Street 2:SUITE 750-118
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-202-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024412207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1574201Medicaid
LAH02311Medicare UPIN
LA5E773Medicare ID - Type Unspecified