Provider Demographics
NPI:1023001724
Name:SHEPPARD, RONALD JOHN (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JOHN
Last Name:SHEPPARD
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:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:NE
Mailing Address - Zip Code:68825-0100
Mailing Address - Country:US
Mailing Address - Phone:308-836-2294
Mailing Address - Fax:308-836-2733
Practice Address - Street 1:213 E KIMBALL ST
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:NE
Practice Address - Zip Code:68825-2589
Practice Address - Country:US
Practice Address - Phone:308-836-2294
Practice Address - Fax:308-836-2733
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2013-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12909207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE277743Medicare PIN
NED17243Medicare UPIN