Healthcare Provider Details

I. General information

NPI: 1174529986
Provider Name (Legal Business Name): DAVID JAMES SHEPHERD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W BROADWAY AVE STE D
ENID OK
73701-3800
US

IV. Provider business mailing address

PO BOX 3046
MALVERN PA
19355-0746
US

V. Phone/Fax

Practice location:
  • Phone: 580-237-0322
  • Fax: 580-233-0402
Mailing address:
  • Phone: 580-237-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12880
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: