Provider Demographics
NPI:1699741108
Name:SHEPARD, DOUGLAS LINDSAY (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LINDSAY
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10097
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0097
Mailing Address - Country:US
Mailing Address - Phone:928-717-9797
Mailing Address - Fax:928-717-2949
Practice Address - Street 1:1000 WILLOW CREEK RD
Practice Address - Street 2:SUITE C
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1645
Practice Address - Country:US
Practice Address - Phone:928-717-9797
Practice Address - Fax:928-717-2949
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2015-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ325602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE1908YMedicare ID - Type Unspecified
AZB89803Medicare UPIN