Provider Demographics
NPI:1376559880
Name:MARK DEVIN SHEPHERD
Entity Type:Organization
Organization Name:MARK DEVIN SHEPHERD
Other - Org Name:ENDOCRINOLOGY CONSULTANTS, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-844-8414
Mailing Address - Street 1:PO BOX 4087
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-4087
Mailing Address - Country:US
Mailing Address - Phone:662-844-8414
Mailing Address - Fax:662-844-8275
Practice Address - Street 1:670 CROSSOVER RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4944
Practice Address - Country:US
Practice Address - Phone:662-844-8414
Practice Address - Fax:662-844-8275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09778731Medicaid
MSCH0754OtherRAILROAD MEDICARE GROUP #
MSC02812Medicare PIN