1235328675 NPI number — MICHAEL D. SHEPHERD M.D. INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235328675 NPI number — MICHAEL D. SHEPHERD M.D. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL D. SHEPHERD M.D. INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235328675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
718 N 11TH AVE
Provider Second Line Business Mailing Address:
STE. D
Provider Business Mailing Address City Name:
HANFORD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93230-3667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-584-1881
Provider Business Mailing Address Fax Number:
559-584-2306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15322 LAKESHORE DR
Provider Second Line Business Practice Location Address:
STE. 201
Provider Business Practice Location Address City Name:
CLEARLAKE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95422-9814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-994-2920
Provider Business Practice Location Address Fax Number:
707-994-2917
Provider Enumeration Date:
10/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHEPHERD
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
707-994-2920

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  G45994 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0082730 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ43971Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com