Provider Demographics
NPI:1043306483
Name:SHIELDS, LAWRENCE SYLVESTER (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:SYLVESTER
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SOUTH NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65897
Mailing Address - Country:US
Mailing Address - Phone:417-836-4000
Mailing Address - Fax:417-836-4075
Practice Address - Street 1:901 SOUTH NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65897
Practice Address - Country:US
Practice Address - Phone:417-836-4000
Practice Address - Fax:417-836-4075
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO32842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A10519Medicare UPIN