Individual
DR. MILTON WIRTZ SHEPPERD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
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
01
—
110141641
RAILROAD MEDICARE
TX
05
—
113654104
—
TX
05
—
113654105
—
TX
Enumeration date
11/11/2006
Last updated
05/05/2009
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