Individual
DR. JOHN RANDALL SHEPHERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
251 N. ILLINOIS HWY. 37, BIG MUDDY CORRECTIONAL CENTER, INA, IL 62846
(618) 437-5300
Mailing address
5389 PERSHING AVE, UNIT C, SAINT LOUIS, MO 63112-1758
(314) 361-8143
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036095033
IL
Other
Enumeration date
10/01/2008
Last updated
10/01/2008
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