Individual
DR. RYAN STEPHEN SHEPPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5901 GRELOT RD, MOBILE, AL 36609-3603
(251) 344-6191
(251) 344-6794
Mailing address
5901 GRELOT RD, MOBILE, AL 36609-3603
(251) 344-6191
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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