Individual
CHARLES JEFFREY SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
560 W 465 N STE 604, PROVIDENCE, UT 84332-8006
(435) 753-1600
(435) 753-9521
Mailing address
560 W 465 N STE 604, PROVIDENCE, UT 84332-8006
(435) 753-1600
(435) 753-9521
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
9379328-1204
UT
207L00000X
Anesthesiology Physician
Primary
DO26527
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028508
—
OR
05
—
1679681167
—
UT
Enumeration date
08/26/2006
Last updated
06/17/2026
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