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General NPI Number Information
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NPI Number | 1235328675
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Entity Type | Organization
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Legal Business Name | MICHAEL D. SHEPHERD M.D. INC.
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 15322 LAKESHORE DR STE. 201
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City | CLEARLAKE
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State | CA
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Zip | 95422-9814
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Country | US
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Telephone | 707-994-2920
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Fax | 707-994-2917
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Provider Business Mailing Address
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Address Line | 718 N 11TH AVE STE. D
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City | HANFORD
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State | CA
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Zip | 93230-3667
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Country | US
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Telephone | 559-584-1881
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Fax | 559-584-2306
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MICHAEL D. SHEPHERD
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Credential | M.D.
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Telephone | 707-994-2920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G45994
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License Number State | CA
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