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General NPI Number Information
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NPI Number | 1376501692
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Entity Type | Individual
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Provider Name | KURTE WALLY SHEPHERD DPM
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 02/20/2009
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Provider Practice Location Address
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Address Line | 4501 CARTWRIGHT RD SUITE 208
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City | MISSOURI CITY
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State | TX
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Zip | 77459-3534
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Country | US
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Telephone | 832-539-1620
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Fax | 832-539-1621
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Provider Business Mailing Address
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Address Line | 10223 BROADWAY ST STE P246
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City | PEARLAND
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State | TX
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Zip | 77584-7880
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Country | US
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Telephone | 832-539-1620
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Fax | 832-539-1621
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1563
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License Number State | TX
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