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NPI Code Detail

MEDICARE: DR. MARY ELIZABETH SHEPHERD M.D.,PH.D.

MEDICARE: DR. MARY ELIZABETH SHEPHERD M.D.,PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology PhysicianH6599TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18B8802OTHERTXBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144210352
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY ELIZABETH SHEPHERD M.D.,PH.D.
Provider Business Mailing Address
First Line : PO BOX 171179
Second Line :
City : AUSTIN
State : TX
Zip : 78717-0041
Country : US
Telephone Number : 512-526-1776
Fax Number : 512-298-1277
Provider Business Practice Location Address
First Line : 12545 RIATA VISTA CIR
Second Line :
City : AUSTIN
State : TX
Zip : 78727-6524
Country : US
Telephone Number : 512-526-1776
Fax Number : 512-298-1277
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2005
Last Update Date : 09/30/2020

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