Provider Demographics
NPI:1508971953
Name:SHEPHERD, JOSEPH NEVILLE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:NEVILLE
Last Name:SHEPHERD
Suffix:JR
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 1:513 BROOKWOOD BLVD
Mailing Address - Street 2:SUITE 50
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6862
Mailing Address - Country:US
Mailing Address - Phone:205-877-2761
Mailing Address - Fax:205-877-2399
Practice Address - Street 1:513 BROOKWOOD BLVD
Practice Address - Street 2:SUITE 50
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6862
Practice Address - Country:US
Practice Address - Phone:205-877-2761
Practice Address - Fax:205-877-2399
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL82594Medicaid
E47609Medicare UPIN
102I117219Medicare PIN