1902871866 NPI number — DR. ROBERT WARREN SHEPLEY M.D.

Table of content: DR. ROBERT WARREN SHEPLEY M.D. (NPI 1902871866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902871866 NPI number — DR. ROBERT WARREN SHEPLEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEPLEY
Provider First Name:
ROBERT
Provider Middle Name:
WARREN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1902871866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
710 COMMERCE DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBURY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55125-4925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-968-5201
Provider Business Mailing Address Fax Number:
651-968-5904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1645 LYNDALE AVE N STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARIBAULT
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55021-2935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-968-5201
Provider Business Practice Location Address Fax Number:
651-968-5904
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  29650 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0918109 . This is a "MEDICA, NORTHFIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 622297800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20628SH . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 983181004381 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0918110 . This is a "MEDICA, FARIBAULT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 106453C572 . This is a "UCARE MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP14382 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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