Healthcare Provider Details

I. General information

NPI: 1417970096
Provider Name (Legal Business Name): DELL A SHEPHERD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MCNEEL LN
NORTH PLATTE NE
69101-6290
US

IV. Provider business mailing address

1201 WILLIAM CT
NORTH PLATTE NE
69101-6309
US

V. Phone/Fax

Practice location:
  • Phone: 308-534-9230
  • Fax: 308-534-5016
Mailing address:
  • Phone: 308-534-9230
  • Fax: 308-534-5016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12720
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: