Provider Demographics
NPI:1790955623
Name:SHEPARD, DALE RANDALL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:RANDALL
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:R35
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-2451
Mailing Address - Fax:216-444-9464
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:R35
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-2451
Practice Address - Fax:216-444-9464
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.007684207RH0003X
OH35.093461207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology