Provider Demographics
NPI:1346436409
Name:R DAVID SHEPARD MD PA
Entity Type:Organization
Organization Name:R DAVID SHEPARD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-876-5089
Mailing Address - Street 1:4224 N TAMPANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6322
Mailing Address - Country:US
Mailing Address - Phone:813-876-5089
Mailing Address - Fax:813-876-5090
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:813-876-5089
Practice Address - Fax:813-876-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54530207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF13033Medicare UPIN
FLK7042Medicare PIN