Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 209452 | MA |
NPI | 1003823295 |
---|---|
Provider Name | James White Shepherd III |
First Address | Harwich, MA 02645-2535 |
Second Address | Harwich, MA 02645-2535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0148521 | (05) | MA |
711548 | HARVARD PILGRIM (01) | MA |
H43820 | (02) | |
J24110 | BCBS (01) | MA |