Provider Demographics
NPI:1285687384
Name:SHIELL, RONALD DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DOUGLAS
Last Name:SHIELL
Suffix:
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 1:2285 CORPORATE CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:1481 FORD ST
Practice Address - Street 2:STE 102
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3916
Practice Address - Country:US
Practice Address - Phone:909-793-2964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70359207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00369772OtherRAILROAD MEDICARE
CA070016367OtherRR MEDICARE FOR NORTHERN CALIF
CA00G703592OtherINDIVIDUAL PTAN NO. CA.
CAWG70359VMedicare PIN
CAWG70359XMedicare PIN
AZZ130600Medicare PIN
CA00G703592OtherINDIVIDUAL PTAN NO. CA.
CAF08741Medicare UPIN
CAAO348ZMedicare PIN
CAAQ348Z -- NRTHRN CAMedicare PIN
CA00G703593Medicare PIN
CAWG70359UMedicare PIN
AZP00369772OtherRAILROAD MEDICARE
CA00G703598Medicare PIN
CA00G703590Medicare PIN
AZZ131415Medicare PIN
CA00G703594Medicare UPIN
ID11002060Medicare PIN
AZ109455Medicare PIN
CAWG70359MMedicare PIN
CA00G703595Medicare UPIN
ID1100206Medicare PIN
AZ120638Medicare PIN
CA070016367OtherRR MEDICARE FOR NORTHERN CALIF
CAWG70359TMedicare PIN
CA00G703597Medicare PIN
CAWG70359LMedicare PIN
CAWG70359WMedicare PIN
CAWG70359YMedicare PIN