Provider Demographics
NPI:1043270598
Name:SHEPHERD, ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:SHEPHERD
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 1:2324 BATH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4330
Mailing Address - Country:US
Mailing Address - Phone:805-682-7801
Mailing Address - Fax:805-569-5861
Practice Address - Street 1:2324 BATH ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4330
Practice Address - Country:US
Practice Address - Phone:805-682-7801
Practice Address - Fax:805-569-5861
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83334207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACI613ZOtherMEDICARE PTAN
CA00A833340Medicaid
CI613ZMedicare PIN
CAA83334Medicare ID - Type Unspecified
CACI613ZOtherMEDICARE PTAN