Healthcare Provider Details

I. General information

NPI: 1316046246
Provider Name (Legal Business Name): SUSAN M SHEPHERD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 CENTENNIAL AVE
BUTTE MT
59701-2870
US

IV. Provider business mailing address

445 CENTENNIAL AVE
BUTTE MT
59701-2870
US

V. Phone/Fax

Practice location:
  • Phone: 406-723-4075
  • Fax: 406-723-3059
Mailing address:
  • Phone: 406-723-4075
  • Fax: 406-723-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8336
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: