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General NPI Number Information
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NPI Number | 1760499867
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Entity Type | Individual
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Provider Name | MARK D SHEPHERD M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 03/04/2010
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Provider Practice Location Address
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Address Line | 670 CROSSOVER RD
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City | TUPELO
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State | MS
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Zip | 38801-4944
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Country | US
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Telephone | 662-844-8414
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Fax | 662-844-7275
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Provider Business Mailing Address
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Address Line | PO BOX 4087
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City | TUPELO
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State | MS
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Zip | 38803-4087
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Country | US
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Telephone | 662-844-4911
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Fax | 662-844-8275
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 14824
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License Number State | MS
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