Provider Demographics
NPI:1174502702
Name:SHEPPARD, GARY J
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:SHEPPARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7777 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 620
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1802
Mailing Address - Country:US
Mailing Address - Phone:713-777-3000
Mailing Address - Fax:713-774-2209
Practice Address - Street 1:7777 SOUTHWEST FWY
Practice Address - Street 2:SUITE 620
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1802
Practice Address - Country:US
Practice Address - Phone:713-777-3000
Practice Address - Fax:713-774-2209
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2326207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110191055OtherRAILROAD MEDICARE NUMBER
TX104556902Medicaid
TX85320NMedicare ID - Type UnspecifiedMEDICARE NUMBER
TX104556902Medicaid