Healthcare Provider Details

I. General information

NPI: 1497743066
Provider Name (Legal Business Name): RAYMOND L SHEPPARD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 WHITESBURG DR SW STE 200
HUNTSVILLE AL
35802
US

IV. Provider business mailing address

4704 WHITESBURG DR SW STE 200
HUNTSVILLE AL
35802-1681
US

V. Phone/Fax

Practice location:
  • Phone: 256-880-4510
  • Fax: 256-880-4512
Mailing address:
  • Phone: 256-533-7064
  • Fax: 256-704-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.23823
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: