Provider Demographics
NPI:1225031271
Name:SHEPHERD, JOHN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:293 OLMSTED BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9191
Mailing Address - Country:US
Mailing Address - Phone:910-295-3344
Mailing Address - Fax:910-295-3165
Practice Address - Street 1:293 OLMSTED BLVD
Practice Address - Street 2:STE 7
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9023
Practice Address - Country:US
Practice Address - Phone:910-295-3344
Practice Address - Fax:910-295-3165
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200200451207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131C9Medicaid
NC89131C9Medicaid
NC2000800Medicare PIN