Provider Demographics
NPI:1255686044
Name:SHEPPARD, JAMES EZRA (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EZRA
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 KATELLA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6410
Mailing Address - Country:US
Mailing Address - Phone:562-855-2700
Mailing Address - Fax:562-855-2710
Practice Address - Street 1:3700 KATELLA AVE STE D
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6410
Practice Address - Country:US
Practice Address - Phone:562-855-2700
Practice Address - Fax:562-855-2710
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 12325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine