Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 55313 | CT |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 269626 | MA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 55313 | CT |
NPI | 1114048329 |
---|---|
Provider Name | Dr. Jonathan Paul Shepherd |
First Address | Farmington, CT 06030-8036 |
Second Address | Farmington, CT 06030-8036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 28/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110128968A | (05) | MA |