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General NPI Number Information
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NPI Number | 1265938351
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Entity Type | Individual
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Provider Name | WILLIAM LOUIS SHEPPARD JR. MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 1250 16TH ST
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City | SANTA MONICA
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State | CA
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Zip | 90404-1249
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Country | US
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Telephone | 424-259-6593
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 35.148024
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A163869
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License Number State | CA
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