Organization
MILTON W. SHEPPERD, DO, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MILTON WIRTZ SHEPPERD DO (PRESIDENT)
(830) 693-1792
Entity
Organization
Contact information
Practice address
113 BROADMOOR ST, MEADOWLAKES, TX 78654-6601
(830) 693-1792
(830) 693-1685
Mailing address
PO BOX 1930, MARBLE FALLS, TX 78654-2680
(830) 693-1792
(830) 693-1685
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
J6722
TX
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
J6722
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0068AA
BLUE CROSS BLUE SHIELD
TX
05
—
176966301
—
TX
05
—
176966302
—
TX
01
—
DG9173
RAILROAD MEDICARE
TX
Enumeration date
11/11/2006
Last updated
05/05/2009
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