Shields, Russell Brent
Shields, Russell Brent is an sole proprietor health care provider with primary practice located at 425 N Medical Dr Ste 108, Bountiful UT 84010. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Shields, Russell Brent can be contacted via phone (801) 292-8444.Contact Information
Primary practice address
425 N Medical Dr Ste 108
Bountiful UT 84010
Phone: (801) 292-8444
Fax: (801) 292-8476
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 1551991205 | Utah |
Profile Details
| NPI number | 1568451730 |
|---|---|
| LBN Legal business name | Shields, Russell Brent |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 19th, 2005 |
| Last updated | Jan 21st, 2008 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568451730 | NPPES |
| Utah | MEDICAID | 04714 |
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