MEDICARE: DR. ROBERT CHARLES SHEPPARD M.D.

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	207RC0001X	Clinical Cardiac Electrophysiology Physician	ME65461	FL
2	174400000X	Specialist	ME65461	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00913624	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26524	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578525937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT CHARLES SHEPPARD M.D.

Provider Business Mailing Address
First Line	:	6006 49TH ST N
Second Line	:	STE. 200
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2148
Country	:	US
Telephone Number	:	727-490-2100
Fax Number	:	727-544-7389

Provider Business Practice Location Address
First Line	:	6006 49TH ST N
Second Line	:	STE. 200
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2148
Country	:	US
Telephone Number	:	727-490-2100
Fax Number	:	727-544-7389

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	02/10/2022

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