Individual
DR. LONI LYNN SHEPHERD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
208 OAK DR S, SUITE 400, LAKE JACKSON, TX 77566-5790
(979) 285-2900
(979) 285-2904
Mailing address
208 OAK DR S, SUITE 400, LAKE JACKSON, TX 77566-5790
(979) 285-2900
(979) 285-2904
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
BP1-0029096
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214871001
—
TX
01
—
4644840750
MYUTMB 4644840750
—
Enumeration date
08/05/2007
Last updated
12/07/2010
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