Provider Demographics
NPI:1891763314
Name:SHEPERD, JAIME M (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:M
Last Name:SHEPERD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JIM
Other - Middle Name:MANUEL
Other - Last Name:SHEPERD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5010
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5010
Mailing Address - Country:US
Mailing Address - Phone:701-857-5650
Mailing Address - Fax:701-857-5031
Practice Address - Street 1:#1 BURDICK EXPY. W.
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4406
Practice Address - Country:US
Practice Address - Phone:701-857-5220
Practice Address - Fax:701-857-5245
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000423732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00765641OtherRAILROAD MEDICARE
P00206069OtherRAILROAD MEDICARE
1112SHOtherREGENCE BLUE SHIELD RIDER
WA8365926Medicaid
1112SHOtherREGENCE BLUE SHIELD RIDER
F93725Medicare UPIN