Provider Demographics
NPI:1467440131
Name:SHEPARD, PAUL E (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:SHEPARD
Suffix:
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 1:10720 BARKER CYPRESS RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-1372
Mailing Address - Country:US
Mailing Address - Phone:281-345-4800
Mailing Address - Fax:281-345-4803
Practice Address - Street 1:10720 BARKER CYPRESS RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1372
Practice Address - Country:US
Practice Address - Phone:281-345-4800
Practice Address - Fax:281-345-4803
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080187123Medicaid
8915B7Medicare ID - Type Unspecified
TX080187123Medicaid