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General NPI Number Information
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NPI Number | 1780836452
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Entity Type | Organization
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Legal Business Name | TIMOTHY S. SHEPHERD MD PA
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Dates
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Enumeration Date | 10/14/2008
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Last Update Date | 04/26/2010
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Provider Practice Location Address
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Address Line | 314 W MAIN ST
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City | LEWISVILLE
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State | TX
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Zip | 75057-3866
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Country | US
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Telephone | 972-420-8777
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Fax |
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Provider Business Mailing Address
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Address Line | 314 W MAIN ST
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City | LEWISVILLE
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State | TX
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Zip | 75057-3866
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Country | US
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Telephone | 972-420-8777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY 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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