Provider Demographics
NPI:1326034885
Name:SHEPARD, ROLAND DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:DAVID
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:DAVID
Other - Last Name:SHEPARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-528-4975
Mailing Address - Fax:
Practice Address - Street 1:4224 N TAMPANIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6322
Practice Address - Country:US
Practice Address - Phone:813-874-1353
Practice Address - Fax:813-355-5962
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54530207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110069380OtherRR MEDICARE
FL110069380OtherRR MEDICARE
FLF13033Medicare UPIN