Provider Demographics
NPI:1972778892
Name:SHEPARD, NATHAN DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:DANIEL
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 OLD SPRINGVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-4005
Mailing Address - Country:US
Mailing Address - Phone:205-838-6000
Mailing Address - Fax:205-838-6999
Practice Address - Street 1:2152 OLD SPRINGVILLE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-4005
Practice Address - Country:US
Practice Address - Phone:205-838-6000
Practice Address - Fax:205-838-6999
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.28475207Q00000X
CO47932207Q00000X
AK6934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36873721Medicaid