Individual
MR. BRYANT MARIO SHEPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
880 EAST IDAHO, LAS CRUCES, NM 88001
(272) 647-2800
(575) 647-2898
Mailing address
1320 S SOLANO, LAS CRUCES, NM 88001
(575) 527-7900
(275) 571-4872
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18677037
—
NM
Enumeration date
07/15/2013
Last updated
03/29/2014
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