Provider Demographics
NPI:1063483998
Name:SHEPHERD, LAQUITA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAQUITA
Middle Name:ANN
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1010 N BELT LINE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-1770
Mailing Address - Country:US
Mailing Address - Phone:972-686-1234
Mailing Address - Fax:972-686-9000
Practice Address - Street 1:1010 N BELT LINE RD STE 105
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149
Practice Address - Country:US
Practice Address - Phone:972-686-1234
Practice Address - Fax:972-686-9000
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH4698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DF664OtherBLUE CROSS
TX8DF664OtherBLUE CROSS
TXTXB154626Medicare PIN