Healthcare Provider Details

I. General information

NPI: 1417943705
Provider Name (Legal Business Name): TERRY PRESTON SHEPHERD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9245 PARK WEST BLVD
KNOXVILLE TN
37923-4425
US

IV. Provider business mailing address

9245 PARK WEST BLVD
KNOXVILLE TN
37923-4425
US

V. Phone/Fax

Practice location:
  • Phone: 865-690-3811
  • Fax: 865-694-7621
Mailing address:
  • Phone: 865-690-3811
  • Fax: 865-694-7621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number14409
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: