Provider Demographics
NPI:1982754941
Name:SHEPARD, LAWRENCE ELWOOD (DO)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ELWOOD
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4636 WESTFORD CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-8356
Mailing Address - Country:US
Mailing Address - Phone:813-264-1963
Mailing Address - Fax:813-968-4510
Practice Address - Street 1:7171 N DALE MABRY HWY
Practice Address - Street 2:SUITE 503
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2630
Practice Address - Country:US
Practice Address - Phone:813-930-8454
Practice Address - Fax:813-930-9554
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS5651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA13865Medicare UPIN
FL802744Medicare ID - Type Unspecified