Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2017021721 | MO |
N | 208600000X | Surgeon | 2017021721 | MO |
Y | 208200000X | Surgeon | MD21994 | ME |
Y | 208600000X | Surgeon | MD21994 | ME |
N | 2086S0102X | Surgical Critical Care | 2017021721 | MO |
N | 2086S0102X | Surgical Critical Care | MD21994 | ME |
NPI | 1053468140 |
---|---|
Provider Name | Dr. Forest Raymond Sheppard |
First Address | Portland, ME 04103-1073 |
Second Address | Portland, ME 04102-3166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 09/03/2018 |