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General NPI Number Information
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NPI Number | 1841495231
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Entity Type | Organization
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Legal Business Name | V. JERRY SHEPHERD, M.D.
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3383 N MERIDIAN AVE
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City | NEWCASTLE
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State | OK
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Zip | 73065-3634
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Country | US
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Telephone | 405-376-0649
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 966
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City | MUSTANG
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State | OK
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Zip | 73064-0966
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Country | US
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Telephone | 405-376-0649
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Fax |
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Authorized Official
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Title or Position | CLAIMS MANAGER
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Name | KRISTIN M HARPER
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Credential |
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Telephone | 405-376-0649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1100X
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Taxonomy Name | Ophthalmic Technician/Technologist
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License Number | 7344
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License Number State | OK
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