Provider Demographics
NPI:1578653010
Name:SHEPPARD, JOHN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1718 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-4791
Mailing Address - Country:US
Mailing Address - Phone:205-507-1100
Mailing Address - Fax:205-553-3318
Practice Address - Street 1:1251 MCFARLAND BLVD NE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2205
Practice Address - Country:US
Practice Address - Phone:205-349-2323
Practice Address - Fax:205-349-1155
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.27322207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1066796Medicaid
AL127467Medicaid
AL511-15303OtherBLUE CROSS BLUE SHIELD
AL511-15303OtherBLUE CROSS BLUE SHIELD
LA4J675Medicare ID - Type Unspecified
AL127467Medicaid