Provider Demographics
NPI:1811976848
Name:SHALES, PAUL D (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:SHALES
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:PSC 819
Mailing Address - Street 2:BOX 50
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09645-0050
Mailing Address - Country:US
Mailing Address - Phone:3495-682-4029
Mailing Address - Fax:3495-682-4032
Practice Address - Street 1:PSC 819
Practice Address - Street 2:BOX 50
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09645-0050
Practice Address - Country:US
Practice Address - Phone:3495-682-4029
Practice Address - Fax:3495-682-4032
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23760171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider