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Individual

DR. GARY N SHIELDS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
340 BANTAM RD, SUITE 1-B, LITCHFIELD, CT 06759-3318
(860) 567-1600
(860) 567-1606
Mailing address
PO BOX 741240, ORANGE CITY, FL 32774-1240
(386) 774-5211
(386) 774-5251

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
000820
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
008003499
CT
05
041318600
FL
01
261444569
PALMETTO GBA DME
SC
01
614459
CONNECTICARE
CT
01
6145090001
DMEPOS
CT
01
6240129
CINGA
CT
Enumeration date
07/24/2006
Last updated
07/28/2009
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