Provider Demographics
NPI:1922059997
Name:SHIELDS, GORDON ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:ALBERT
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 1:302 MERCHANTS WALK 100
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2291
Mailing Address - Country:US
Mailing Address - Phone:205-523-9300
Mailing Address - Fax:205-523-9301
Practice Address - Street 1:302 MERCHANTS WALK STE 100
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2291
Practice Address - Country:US
Practice Address - Phone:205-523-9300
Practice Address - Fax:205-523-9301
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00026424207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009994165Medicaid
AL51000907OtherBCBS
ALI32510Medicare UPIN
AL051556189Medicare ID - Type UnspecifiedMEDICARE
AL009994165Medicaid