Provider Demographics
NPI:1659510329
Name:WEST BOYLSTON FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:WEST BOYLSTON FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:SR
Authorized Official - Credentials:DO
Authorized Official - Phone:508-886-7865
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01543-0367
Mailing Address - Country:US
Mailing Address - Phone:508-886-7865
Mailing Address - Fax:
Practice Address - Street 1:259 MAIN ST.
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:MA
Practice Address - Zip Code:01543-0367
Practice Address - Country:US
Practice Address - Phone:508-886-7865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty