Provider Demographics
NPI:1629149810
Name:MILTON W. SHEPPERD, DO, PA
Entity Type:Organization
Organization Name:MILTON W. SHEPPERD, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:WIRTZ
Authorized Official - Last Name:SHEPPERD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:830-693-1792
Mailing Address - Street 1:PO BOX 1930
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-2680
Mailing Address - Country:US
Mailing Address - Phone:830-693-1792
Mailing Address - Fax:830-693-1685
Practice Address - Street 1:113 BROADMOOR ST
Practice Address - Street 2:
Practice Address - City:MEADOWLAKES
Practice Address - State:TX
Practice Address - Zip Code:78654-6601
Practice Address - Country:US
Practice Address - Phone:830-693-1792
Practice Address - Fax:830-693-1685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-11
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6722207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176966302Medicaid
TX176966301Medicaid
TXDG9173OtherRAILROAD MEDICARE
TX0068AAOtherBLUE CROSS BLUE SHIELD
TX176966302Medicaid
TX0068AAOtherBLUE CROSS BLUE SHIELD