Individual
RUSSELL BRENT SHIELDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
425 N MEDICAL DR, STE 108, BOUNTIFUL, UT 84010
(801) 292-8444
(801) 292-8476
Mailing address
425 N MEDICAL DR, STE 108, BOUNTIFUL, UT 84010
(801) 292-8444
(801) 292-8476
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1551991205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04714
—
UT
Enumeration date
10/19/2005
Last updated
01/21/2008
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