Individual
SCOTT R SHEPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3509 N BROAD ST, SUITE 724, PHILADELPHIA, PA 19140-4105
(215) 707-7200
(215) 707-3831
Mailing address
2450 W HUNTING PARK AVE, STE R.705, PHILADELPHIA, PA 19129-1302
(215) 707-7200
(215) 707-3831
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
MA067529
NJ
207T00000X
Neurological Surgery Physician
Primary
MD459537
PA
207T00000X
Neurological Surgery Physician
N0457
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196101301
—
TX
05
—
7624107
—
NJ
01
—
8S5475
BCBSTX
TX
Enumeration date
08/29/2006
Last updated
01/18/2017
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