Provider Demographics
NPI:1720034937
Name:SHIELDS, WRIGHT DAVIS (MD)
Entity Type:Individual
Prefix:
First Name:WRIGHT
Middle Name:DAVIS
Last Name:SHIELDS
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:PO BOX 12248
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2248
Mailing Address - Country:US
Mailing Address - Phone:252-633-5333
Mailing Address - Fax:252-633-9443
Practice Address - Street 1:702 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5238
Practice Address - Country:US
Practice Address - Phone:252-633-5333
Practice Address - Fax:252-633-9443
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8975913Medicaid
NC75913OtherBCBS OF NC
NC2158695BMedicare PIN
NC110158087Medicare PIN
NC75913OtherBCBS OF NC
NCD88974Medicare UPIN