Individual
MARK J SHEPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7442 FRANK AVE NW, NORTH CANTON, OH 44720-7022
(330) 305-0838
(330) 305-2514
Mailing address
7442 FRANK AVE NW, NORTH CANTON, OH 44720-7022
(330) 455-5367
(330) 455-6114
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
35068710
OH
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
34068710
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0156941
—
OH
01
—
H234290
MEDICARE ID-TYPE UNSPECIFIED
OH
Enumeration date
10/06/2005
Last updated
09/30/2020
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