Organization
RUSSELL B SHIELDS MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL BRENT SHIELDS (PRESIDENT)
(801) 292-8444
Entity
Organization
Contact information
Practice address
425 MEDICAL DR, STE 108, BOUNTIFUL, UT 84010-4945
(801) 292-8444
(801) 292-8476
Mailing address
425 MEDICAL DR, STE 108, BOUNTIFUL, UT 84010-4945
(801) 292-8444
(801) 292-8476
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528566304004
—
UT
Enumeration date
10/24/2005
Last updated
04/08/2008
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