Provider Demographics
NPI:1629114020
Name:YOUR FAMILY DOCTOR, PC
Entity Type:Organization
Organization Name:YOUR FAMILY DOCTOR, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-836-7650
Mailing Address - Street 1:3939 W RIDGE RD
Mailing Address - Street 2:SUITE A-101
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-1879
Mailing Address - Country:US
Mailing Address - Phone:814-836-7650
Mailing Address - Fax:814-836-7690
Practice Address - Street 1:3939 W RIDGE RD
Practice Address - Street 2:SUITE A-101
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1879
Practice Address - Country:US
Practice Address - Phone:814-836-7650
Practice Address - Fax:814-836-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty