Provider Demographics
NPI:1326151234
Name:SHEPHERD, LAUREL A (MD)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:A
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 FORT UNION BLVD STE 125
Mailing Address - Street 2:URGENT CARE ADMINISTRATION
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1871
Mailing Address - Country:US
Mailing Address - Phone:801-233-4400
Mailing Address - Fax:
Practice Address - Street 1:1225 FORT UNION BLVD STE 125
Practice Address - Street 2:URGENT CARE ADMIN
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1871
Practice Address - Country:US
Practice Address - Phone:801-233-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT901835821205207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine