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NPI Code Detail

MEDICARE: TERRY PRESTON SHEPHERD M.D.

MEDICARE: TERRY PRESTON SHEPHERD M.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
1208800000XUrology Physician14409TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
20347510001OTHERTNMEDICARE NSC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417943705
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY PRESTON SHEPHERD M.D.
Provider Business Mailing Address
First Line : 9245 PARK WEST BLVD
Second Line :
City : KNOXVILLE
State : TN
Zip : 37923-4425
Country : US
Telephone Number : 865-690-3811
Fax Number : 865-694-7621
Provider Business Practice Location Address
First Line : 9245 PARK WEST BLVD
Second Line :
City : KNOXVILLE
State : TN
Zip : 37923-4425
Country : US
Telephone Number : 865-690-3811
Fax Number : 865-694-7621
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2005
Last Update Date : 01/04/2011

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