Individual
DR. MARY ELIZABETH SHEPHERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.,PH.D.
Contact information
Practice address
12545 RIATA VISTA CIR, AUSTIN, TX 78727-6524
(512) 526-1776
(512) 298-1277
Mailing address
PO BOX 171179, AUSTIN, TX 78717-0041
(512) 526-1776
(512) 298-1277
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
H6599
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105402503
—
TX
01
—
8B8802
BLUE CROSS BLUE SHIELD
TX
Enumeration date
10/27/2005
Last updated
09/30/2020
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