MEDICARE: DR. FOREST RAYMOND SHEPPARD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	35.154799	OH
2	208600000X	Surgery Physician	MD21994	ME
3	2086S0102X	Surgical Critical Care Physician	MD21994	ME
4	2086S0102X	Surgical Critical Care Physician	2017021721	MO
5	2086S0102X	Surgical Critical Care Physician	35.154799	OH
6	208600000X	Surgery Physician	2017021721	MO

General Provider Information

NPI Number	:	1053468140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FOREST RAYMOND SHEPPARD MD

Provider Business Mailing Address
First Line	:	3000 ARLINGTON AVE STOP 1108
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2595
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 ARLINGTON AVE STE 2C
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2595
Country	:	US
Telephone Number	:	419-383-3759
Fax Number	:	419-383-2962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	12/10/2025

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