Provider Demographics
NPI:1063500825
Name:JAMES E SHEPARD MARK C LAMBERT & LAWRENCE A LEVY PTRS
Entity Type:Organization
Organization Name:JAMES E SHEPARD MARK C LAMBERT & LAWRENCE A LEVY PTRS
Other - Org Name:SHEPARD LAMBERT LEVY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:GALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-925-3075
Mailing Address - Street 1:1300 S ELISEO DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2023
Mailing Address - Country:US
Mailing Address - Phone:415-925-3075
Mailing Address - Fax:415-925-3070
Practice Address - Street 1:1300 S ELISEO DR
Practice Address - Street 2:SUITE 104
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2023
Practice Address - Country:US
Practice Address - Phone:415-925-3075
Practice Address - Fax:415-925-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY48896YMedicaid
CA00G212390Medicare UPIN
CA00G232810Medicare UPIN
CAA31902Medicare UPIN
CAA41215Medicare UPIN
CA00G84220Medicare UPIN
CAA58443Medicare UPIN
CAYYY48896YMedicare PIN
CA9866215Medicare PIN
CAYYY48896YMedicaid
CADE018ZMedicare PIN