Healthcare Provider Details

I. General information

NPI: 1427749365
Provider Name (Legal Business Name): EZEKIEL TODD SHEPARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EZEKIEL TODD CLINARD

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 TIETON DR
YAKIMA WA
98902-3761
US

IV. Provider business mailing address

2811 TIETON DR
YAKIMA WA
98902-3761
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.MD.70102215
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: