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General NPI Number Information
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NPI Number | 1255655007
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Entity Type | Organization
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Legal Business Name | TIM SHEPHERD MD PA
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 500 N VALLEY PKWY STE 101
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City | LEWISVILLE
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State | TX
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Zip | 75067-3552
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Country | US
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Telephone | 972-420-8777
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Fax | 972-219-1978
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Provider Business Mailing Address
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Address Line | 500 N VALLEY PKWY STE 101
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City | LEWISVILLE
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State | TX
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Zip | 75067-3552
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Country | US
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Telephone | 972-420-8777
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Fax | 972-219-1978
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIM S SHEPHERD
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Credential | MD
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Telephone | 972-420-8777
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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 | F4518
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License Number State | TX
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