1821062449 NPI number — BRIAN T SHIELDS MD

Table of content: BRIAN T SHIELDS MD (NPI 1821062449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821062449 NPI number — BRIAN T SHIELDS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIELDS
Provider First Name:
BRIAN
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821062449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5788
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80217-5788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-903-6191
Provider Business Mailing Address Fax Number:
303-202-1281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11600 W 2ND PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80228-1527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-321-4161
Provider Business Practice Location Address Fax Number:
720-321-4165
Provider Enumeration Date:
02/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  34182 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8472367 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01341825 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200384160A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 128174 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00299482 . This is a "RR MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: Z3275 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: S2113 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122708400 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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