Provider Demographics
NPI:1518969369
Name:SHEWARD, JERRY E (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:E
Last Name:SHEWARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9615 E 148TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4360
Mailing Address - Country:US
Mailing Address - Phone:317-587-0500
Mailing Address - Fax:317-674-0059
Practice Address - Street 1:2009 BROWN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4216
Practice Address - Country:US
Practice Address - Phone:317-574-1254
Practice Address - Fax:317-674-0060
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01032845A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01032845BOtherCDS NUMBER
IL200006300Medicaid
INAS2545943OtherDEA NUMBER
IN945920HMedicare PIN
IN01032845BOtherCDS NUMBER