Provider Demographics
NPI:1821045097
Name:SHEPHERD, GERARD PATRICK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:PATRICK
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SAXFORD PL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8185
Mailing Address - Country:US
Mailing Address - Phone:919-806-3771
Mailing Address - Fax:
Practice Address - Street 1:5716 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9089
Practice Address - Country:US
Practice Address - Phone:919-572-1868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101463363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS72814Medicare UPIN
NC2750101Medicare PIN