Provider Demographics
NPI:1710498043
Name:LAQUITA A SHEPHERD, MD PLLC
Entity Type:Organization
Organization Name:LAQUITA A SHEPHERD, MD PLLC
Other - Org Name:NOVELLA FAMILY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAQUITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-532-3756
Mailing Address - Street 1:1010 N BELT LINE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-1700
Mailing Address - Country:US
Mailing Address - Phone:972-686-1234
Mailing Address - Fax:972-686-9000
Practice Address - Street 1:1010 N BELT LINE RD STE 105
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-1700
Practice Address - Country:US
Practice Address - Phone:972-686-1234
Practice Address - Fax:972-686-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty