Provider Demographics
NPI:1578815676
Name:SHEPARD, BRIAN ALAN (CSFA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ALAN
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 SYBEL DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-3103
Mailing Address - Country:US
Mailing Address - Phone:251-648-4389
Mailing Address - Fax:
Practice Address - Street 1:2220 SYBEL DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-3103
Practice Address - Country:US
Practice Address - Phone:251-648-4389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant