Provider Demographics
NPI:1942498134
Name:F E SHEPARD JR MD PC
Entity Type:Organization
Organization Name:F E SHEPARD JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:276-679-7600
Mailing Address - Street 1:1412 PARK AVE NW
Mailing Address - Street 2:PO BOX 681
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1602
Mailing Address - Country:US
Mailing Address - Phone:276-679-7600
Mailing Address - Fax:276-679-0738
Practice Address - Street 1:1412 PARK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1602
Practice Address - Country:US
Practice Address - Phone:276-679-7600
Practice Address - Fax:276-679-0738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA208800000X208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010124018Medicaid
VA010124018Medicaid