Provider Demographics
NPI:1508861949
Name:SHIELDS, PAUL EUGENE (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:EUGENE
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 CHURCHILL HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1375
Mailing Address - Country:US
Mailing Address - Phone:330-759-6750
Mailing Address - Fax:330-759-6755
Practice Address - Street 1:2501 W 12TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4527
Practice Address - Country:US
Practice Address - Phone:814-806-1144
Practice Address - Fax:814-833-0659
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010676L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03446839Medicaid
PA001370726OtherHIGHMARK BCBS
PA0018397920004Medicaid
PA001370726OtherHIGHMARK BCBS
PA0018397920004Medicaid