Provider Demographics
NPI:1265485585
Name:SHEPARD, FELIX EUGENE JR (MD)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:EUGENE
Last Name:SHEPARD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-0681
Mailing Address - Country:US
Mailing Address - Phone:276-679-7600
Mailing Address - Fax:
Practice Address - Street 1:98 15TH ST NW
Practice Address - Street 2:BUILDING #2 SUITE #207
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1600
Practice Address - Country:US
Practice Address - Phone:276-679-7600
Practice Address - Fax:276-679-0738
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053138208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010124018Medicaid
C09381Medicare UPIN
VA010124018Medicaid