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Organization
GARY N. SHIELDS DPM LLC
Active
Organization
GARY N. SHIELDS DPM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA AUTRY (AGENT)
(386) 774-5211
Entity
Organization
Contact information
Practice address
340 BANTAM RD, SUITE 1-B, LITCHFIELD, CT 06759-3318
(860) 567-1600
Mailing address
PO BOX 741240, ORANGE CITY, FL 32774-1240
(386) 774-5211
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041318600
—
FL
01
—
4624525
AETNA
CT
01
—
614459
CONNECTICARE
CT
01
—
6145090001
DMEPOS
CT
01
—
6240129
CIGNA
CT
Enumeration date
05/02/2008
Last updated
05/05/2009
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