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NPI Code Detail

MEDICARE: DR. KELVIN DWAYNE SHEPHERD D.O.

MEDICARE: DR. KELVIN DWAYNE SHEPHERD D.O.
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
1207Q00000XFamily Medicine PhysicianM0917TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154359503
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELVIN DWAYNE SHEPHERD D.O.
Provider Business Mailing Address
First Line : 412 TELEPHONE RD
Second Line :
City : HOUSTON
State : TX
Zip : 77023-1840
Country : US
Telephone Number : 713-926-6229
Fax Number : 713-926-9105
Provider Business Practice Location Address
First Line : 927 E SHAW AVE
Second Line :
City : PASADENA
State : TX
Zip : 77506-1430
Country : US
Telephone Number : 713-982-5900
Fax Number : 713-982-5944
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2006
Last Update Date : 01/10/2012

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