Provider Demographics
NPI:1003823295
Name:SHEPHERD, JAMES WHITE III (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WHITE
Last Name:SHEPHERD
Suffix:III
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 1:253 PLEASANT LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-2535
Mailing Address - Country:US
Mailing Address - Phone:508-432-5233
Mailing Address - Fax:508-430-0511
Practice Address - Street 1:253 PLEASANT LAKE AVE
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-2535
Practice Address - Country:US
Practice Address - Phone:508-432-5233
Practice Address - Fax:508-430-0511
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ24110OtherBCBS
MA0148521Medicaid
MA711548OtherHARVARD PILGRIM
H43820Medicare UPIN
A32748Medicare ID - Type Unspecified