Provider Demographics
NPI:1245203561
Name:SHIELDS, WILLIAM WADE (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WADE
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1035 WELLINGTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8122
Mailing Address - Country:US
Mailing Address - Phone:970-242-6600
Mailing Address - Fax:970-243-7520
Practice Address - Street 1:1035 WELLINGTON AVENUE, STE 101
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501
Practice Address - Country:US
Practice Address - Phone:970-242-6600
Practice Address - Fax:970-243-7520
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A11059207RG0100X
CO0053228207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology