Provider Demographics
NPI:1700821790
Name:SHIELDS, SAM J (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:J
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2550 NORTH HOLLYWOOD WAY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-5019
Mailing Address - Country:US
Mailing Address - Phone:818-557-0135
Mailing Address - Fax:818-557-1394
Practice Address - Street 1:1401 GARCES HIGHWAY
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-3690
Practice Address - Country:US
Practice Address - Phone:661-721-5262
Practice Address - Fax:661-721-5254
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
CAC28997207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C289970OtherCALOPTIMA
CAC28997OtherBLUE CROSS
CA00C289970Medicaid
CA00C289970OtherBLUE SHIELD
CA050608CA33806OtherDELANO TRAILBLAZER
CAP00282262OtherDELANO RAILROAD
CA050608CA33806OtherDELANO TRAILBLAZER
CA00C289970OtherBLUE SHIELD