Provider Demographics
NPI:1508886235
Name:ABERNATHY, SHIELDS BREWSTER (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIELDS
Middle Name:BREWSTER
Last Name:ABERNATHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1050 LAS TABLAS RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9729
Mailing Address - Country:US
Mailing Address - Phone:805-434-1000
Mailing Address - Fax:805-434-3265
Practice Address - Street 1:1050 LAS TABLAS RD
Practice Address - Street 2:SUITE 3
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9729
Practice Address - Country:US
Practice Address - Phone:805-434-1000
Practice Address - Fax:805-434-3265
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2017-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG42752207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
77-0049521OtherFEIN NUMBER
CA00G427520Medicaid
CAA89763Medicare UPIN