Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | LO22 | OK |
Y | 222Z00000X | Podiatrist | LO22 | OK |
N | 225000000X | Orthotic Fitter | LO22 | OK |
NPI | 1548407299 |
---|---|
Provider Name | Harry P Sheppard |
First Address | Tulsa, OK 74104-4614 |
Second Address | Tulsa, OK 74104-4614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2009 |
Last Update Date | 17/01/2009 |