MEDICARE: DAVID JAMES SHEPHERD JR. MD

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
1	207R00000X	Internal Medicine Physician	12880	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00066745	OTHER		RAILROAD MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	730776935005	OTHER		BLUE CROSS ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174529986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID JAMES SHEPHERD JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 3046
Second Line	:
City	:	MALVERN
State	:	PA
Zip	:	19355-0746
Country	:	US
Telephone Number	:	580-237-0322
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 W BROADWAY AVE STE D
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73701-3800
Country	:	US
Telephone Number	:	580-237-0322
Fax Number	:	580-233-0402

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	03/07/2023

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