Provider Demographics
NPI:1194832360
Name:SHEPPARD, STEPHEN R (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 MEMORIAL HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1787
Mailing Address - Country:US
Mailing Address - Phone:251-344-1151
Mailing Address - Fax:251-344-2113
Practice Address - Street 1:101 MEMORIAL HOSPITAL DRIVE
Practice Address - Street 2:SUITE 309
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1787
Practice Address - Country:US
Practice Address - Phone:251-344-1151
Practice Address - Fax:251-344-2113
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2013-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL10348208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C75701Medicare UPIN
AL51017398Medicare ID - Type Unspecified