Provider Demographics
NPI:1689070047
Name:DR. SCOTT L. SHIELDS, P.C.
Entity Type:Organization
Organization Name:DR. SCOTT L. SHIELDS, P.C.
Other - Org Name:TOTAL FOOT & ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:580-237-3338
Mailing Address - Street 1:3330 NW 56TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4479
Mailing Address - Country:US
Mailing Address - Phone:405-947-8041
Mailing Address - Fax:405-947-8043
Practice Address - Street 1:3330 NW 56TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4479
Practice Address - Country:US
Practice Address - Phone:405-947-8041
Practice Address - Fax:405-947-8043
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. SCOTT L. SHIELDS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK189213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK300522342Medicare PIN