Healthcare Provider Details

I. General information

NPI: 1558389015
Provider Name (Legal Business Name): JAMES B SHEPHERD III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FOREST PARK AVE DEPT OPHTHALMOLOGY, 6TH FL
SAINT LOUIS MO
63108-1495
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-3937
  • Fax: 314-362-3725
Mailing address:
  • Phone: 314-362-3937
  • Fax: 314-362-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number2001027205
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: