MEDICARE: DR. ROLAND DAVID SHEPARD 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	207RG0100X	Gastroenterology Physician	ME54530	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110069380	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326034885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROLAND DAVID SHEPARD MD

Provider Business Mailing Address
First Line	:	38135 MARKET SQ
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-7505
Country	:	US
Telephone Number	:	813-528-4975
Fax Number	:

Provider Business Practice Location Address
First Line	:	4224 N TAMPANIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6322
Country	:	US
Telephone Number	:	813-874-1353
Fax Number	:	813-355-5962

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	08/27/2021

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