Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 20-22391 | SC |
NPI | 1144219296 |
---|---|
Provider Name | Arthur J Shepard III |
First Address | Charleston, SC 29406-9104 |
Second Address | Charleston, SC 29406-9104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F25779 | (02) | SC |