Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5437 | AL |
N | 204E00000X | Oral & Maxillofacial Surgeon | ALABAMA 5437 | TX |
NPI | 1396936589 |
---|---|
Provider Name | Dr. Ryan Stephen Sheppard |
First Address | Mobile, AL 36609-3603 |
Second Address | Mobile, AL 36609-3603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 24/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05454 | BCBS (01) | AL |
1021853899 | MEDICARE PTAN (01) | AL |
3860118990 | MYUTMB 3860118990 (01) |