Healthcare Provider Details

I. General information

NPI: 1023001724
Provider Name (Legal Business Name): RONALD JOHN SHEPPARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 10/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E KIMBALL ST
CALLAWAY NE
68825-2589
US

IV. Provider business mailing address

PO BOX 100
CALLAWAY NE
68825-0100
US

V. Phone/Fax

Practice location:
  • Phone: 308-836-2294
  • Fax: 308-836-2733
Mailing address:
  • Phone: 308-836-2294
  • Fax: 308-836-2733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12909
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: