Individual
DR. RYAN STEPHEN SHEPPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5437
AL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
ALABAMA 5437
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05454
BCBS
AL
01
—
1021853899
MEDICARE PTAN
AL
01
—
3860118990
MYUTMB 3860118990
—
Enumeration date
08/05/2007
Last updated
01/24/2012
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