MEDICARE: B.B.SHEPPARD MD, INC.

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	174400000X	Specialist	G065691	CA

General Provider Information

NPI Number	:	1891828018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B.B.SHEPPARD MD, INC.

Provider Business Mailing Address
First Line	:	1468 25TH ST
Second Line	:	UNIT 301
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94107-7411
Country	:	US
Telephone Number	:	415-796-2442
Fax Number	:

Provider Business Practice Location Address
First Line	:	1468 25TH ST
Second Line	:	UNIT 301
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94107-7411
Country	:	US
Telephone Number	:	415-796-2442
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BARRY B. SHEPPARD
Credential	:	M.D.
Telephone Number	:	415-796-2442

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	10/07/2010

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