Individual
MATTHEW SHEPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
211 SAINT FRANCIS DR, CAPE GIRARDEAU, MO 63703-5049
(573) 331-5770
(573) 331-3974
Mailing address
PO BOX 801143, KANSAS CITY, MO 64180-1143
(573) 331-5583
(573) 331-5076
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
113520
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110210851
RAILROAD MEDICARE
—
01
—
117199
BCBS
MO
05
—
150428001
—
AR
05
—
208841411
—
MO
01
—
332821
HEALTHLINK
—
05
—
64069206
—
KY
Enumeration date
01/17/2007
Last updated
02/26/2021
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