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NPI Code Detail

MEDICARE: DR. JON M SHEPARD L.P.

MEDICARE:  DR. JON M SHEPARD  L.P.
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
1103T00000XPsychologist33286TX
2103TS0200XSchool Psychologist32747TX

General Provider Information

NPI Number : 1861725921
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JON M SHEPARD L.P.
Provider Business Mailing Address
First Line : 2816 MUSKRAT DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-5501
Country : US
Telephone Number : 817-229-5659
Fax Number :
Provider Business Practice Location Address
First Line : 4020 HUFFINES
Second Line : SUITE 120
City : CARROLLTON
State : TX
Zip : 75010-6524
Country : US
Telephone Number : 817-229-5659
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2009
Last Update Date : 09/08/2009

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Directions to “ DR. JON M SHEPARD L.P.” Practice Location

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