Individual
RONALD DOUGLAS SHIELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1481 FORD ST, STE 102, REDLANDS, CA 92373-3916
(909) 793-2964
Mailing address
2285 CORPORATE CIR, STE 200, HENDERSON, NV 89074-7759
(702) 360-2763
(949) 783-2880
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
G70359
CA
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
G70359
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G703592
INDIVIDUAL PTAN NO. CA.
CA
01
—
070016367
RR MEDICARE FOR NORTHERN CALIF
CA
01
—
P00369772
RAILROAD MEDICARE
AZ
Enumeration date
05/18/2006
Last updated
03/16/2016
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