Healthcare Provider Details

I. General information

NPI: 1811985070
Provider Name (Legal Business Name): JOHN CAMP SHEPHERD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W SOUTH BOULDER RD
LAFAYETTE CO
80026-1389
US

IV. Provider business mailing address

1345 PLAZA CT N STE 1A
LAFAYETTE CO
80026-2832
US

V. Phone/Fax

Practice location:
  • Phone: 303-665-9310
  • Fax:
Mailing address:
  • Phone: 303-665-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number23339
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: