Healthcare Provider Details

I. General information

NPI: 1952325961
Provider Name (Legal Business Name): STEVEN P SHEPHERD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 COLBY AVE
EVERETT WA
98201-1665
US

IV. Provider business mailing address

27798 HARRISON WOODS LN
HARRISON TOWNSHIP MI
48045-3547
US

V. Phone/Fax

Practice location:
  • Phone: 425-261-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberOP00002110
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: