Individual
TIMOTHY D SHIELDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2412 N COMMERCE ST, ARDMORE, OK 73401-1356
(580) 226-5000
(580) 226-5035
Mailing address
PO BOX 5978, ARDMORE, OK 73403-0978
(580) 226-5000
(580) 226-5035
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R0064541
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200021240A
—
OK
01
—
OK401908
MEDICARE ID-TYPE UNSPECIFIED
OK
Enumeration date
05/25/2006
Last updated
10/01/2009
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