Provider Demographics
NPI:1437133436
Name:SHIELDS, SCOTT LAMAR (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LAMAR
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 N VAN BUREN
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-4455
Mailing Address - Country:US
Mailing Address - Phone:580-237-3338
Mailing Address - Fax:580-237-3399
Practice Address - Street 1:524 N VAN BUREN
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-4455
Practice Address - Country:US
Practice Address - Phone:580-237-3338
Practice Address - Fax:580-237-3399
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK189213E00000X
NC368213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1754470500OtherDEPT. OF LABOR
7315168723701A001OtherTRICARE
OK100779730AMedicaid
7315168723701A001OtherTRICARE
OK100779730AMedicaid