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Individual
MARTY W SHIELDS
Active
Individual
MARTY W SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H0814
TX
208600000X
Surgery Physician
H0814
TX
2086S0129X
Vascular Surgery Physician
H 0814
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038142802
—
TX
05
—
200234310 A
—
OK
05
—
47924772
—
NM
05
—
PO80T6168
—
TX
Enumeration date
01/05/2007
Last updated
10/12/2016
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