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Organization
TIM SHEPHERD MD PA
Active
Organization
TIM SHEPHERD MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIM S SHEPHERD MD (OWNER)
(972) 420-8777
Entity
Organization
Contact information
Practice address
500 N VALLEY PKWY, STE 101, LEWISVILLE, TX 75067-3552
(972) 420-8777
(972) 219-1978
Mailing address
500 N VALLEY PKWY, STE 101, LEWISVILLE, TX 75067-3552
(972) 420-8777
(972) 219-1978
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
F4518
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00Z699
BLUE CROSS/BLUE SHIELD
TX
05
—
212009901
—
TX
01
—
B26392
COMMERCIAL
TX
01
—
DQ2129
RAILROAD MEDICARE
TX
Enumeration date
03/23/2010
Last updated
09/30/2010
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