Provider Demographics
NPI:1003819863
Name:SHEPARD, DANIEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 E STOWELL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7001
Mailing Address - Country:US
Mailing Address - Phone:805-347-8779
Mailing Address - Fax:805-614-4933
Practice Address - Street 1:910 E STOWELL RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7001
Practice Address - Country:US
Practice Address - Phone:805-347-8779
Practice Address - Fax:805-614-4933
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69671174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1312330001OtherMEDICARE DMERC
CA180045185OtherMEDICARE RAILROAD
CA00A696710Medicaid
CA00A696710Medicaid
CA180045185OtherMEDICARE RAILROAD
CAWA69671BMedicare PIN