Individual
MICHAEL SHEPARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RAS
Contact information
Practice address
564 S DORA ST, SUITE D, UKIAH, CA 95482-5486
(800) 555-5906
(707) 472-0121
Mailing address
564 S DORA ST, SUITE D, UKIAH, CA 95482-5486
(800) 555-5906
(707) 472-0121
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
A8074031
CA
Other
Enumeration date
09/25/2014
Last updated
09/25/2014
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