Provider Demographics
NPI:1700067915
Name:SHEPHERD, JAMES THOMSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:THOMSON
Last Name:SHEPHERD
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 1:2501 JIMMY JOHNSON BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2011
Mailing Address - Country:US
Mailing Address - Phone:409-344-9087
Mailing Address - Fax:094-344-9095
Practice Address - Street 1:2501 JIMMY JOHNSON BLVD STE 302
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2011
Practice Address - Country:US
Practice Address - Phone:409-344-9087
Practice Address - Fax:094-344-9095
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6616207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126406106Medicaid
TX126406106Medicaid
TX111900159OtherPALMETTO GBA RR MEDICARE
TXTXB153215Medicare PIN
TX111900159OtherPALMETTO GBA RR MEDICARE