Provider Demographics
NPI:1619954237
Name:SHIELD, STEVEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
Last Name:SHIELD
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 1:14400 JACKSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95327-9567
Mailing Address - Country:US
Mailing Address - Phone:209-962-7121
Mailing Address - Fax:209-962-0665
Practice Address - Street 1:18661 STATE HIGHWAY 120
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:CA
Practice Address - Zip Code:95321-9701
Practice Address - Country:US
Practice Address - Phone:209-962-7121
Practice Address - Fax:209-962-0665
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAG66861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF13009Medicare UPIN
CAF13009Medicare ID - Type Unspecified