Provider Demographics
NPI:1760488027
Name:SHEPHERD, TIM (MD)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N VALLEY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3479
Mailing Address - Country:US
Mailing Address - Phone:972-420-8777
Mailing Address - Fax:
Practice Address - Street 1:500 N VALLEY PKWY
Practice Address - Street 2:STE 101
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067
Practice Address - Country:US
Practice Address - Phone:972-420-8777
Practice Address - Fax:972-219-1978
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB26392OtherCOMMERCIAL
TX00DQ67OtherBLUE CROSS
TX114490905Medicaid
TXP00822864OtherRAILROAD MEDICARE
TX00DQ67OtherBLUE CROSS