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Organization

SHEPHERDS PEDIATRIC CARE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LONI LYNN SHEPHERD M.D. (OWNER)
(979) 297-3949
Entity
Organization

Contact information

Practice address
106 CIRCLE WAY ST, SUITE A, LAKE JACKSON, TX 77566-5202
(979) 297-3949
(979) 297-3919
Mailing address
106 CIRCLE WAY ST, SUITE A, LAKE JACKSON, TX 77566-5202
(979) 297-3949
(979) 297-3919

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
N6017
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
214871001
TX
Enumeration date
01/30/2014
Last updated
03/10/2014
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