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General NPI Number Information
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NPI Number | 1710498043
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Entity Type | Organization
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Legal Business Name | LAQUITA A SHEPHERD, MD PLLC
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Dates
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Enumeration Date | 10/13/2017
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Last Update Date | 04/04/2019
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Provider Practice Location Address
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Address Line | 1010 N BELT LINE RD STE 105
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City | MESQUITE
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State | TX
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Zip | 75149-1700
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Country | US
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Telephone | 972-686-1234
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Fax | 972-686-9000
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Provider Business Mailing Address
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Address Line | 1010 N BELT LINE RD STE 105
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City | MESQUITE
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State | TX
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Zip | 75149-1700
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Country | US
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Telephone | 972-686-1234
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Fax | 972-686-9000
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Authorized Official
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Title or Position | OWNER
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Name | LAQUITA A SHEPHERD
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Credential | MD
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Telephone | 214-532-3756
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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 | H4698
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License Number State | TX
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