Provider Demographics
NPI:1922285295
Name:SHELLEY M. SHEPARD M.D.P.C.
Entity Type:Organization
Organization Name:SHELLEY M. SHEPARD M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-685-0130
Mailing Address - Street 1:PO BOX 1601
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-1601
Mailing Address - Country:US
Mailing Address - Phone:307-685-0130
Mailing Address - Fax:307-687-7243
Practice Address - Street 1:1206 W 4TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3300
Practice Address - Country:US
Practice Address - Phone:307-685-0130
Practice Address - Fax:307-687-7243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6299A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty