Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 04-39108 | KS |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 04-39108 | KS |
NPI | 1225357189 |
---|---|
Provider Name | Jeffrey Shepherd |
First Address | Wichita, KS 67226-8112 |
Second Address | Wichita, KS 67226-8112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2010 |
Last Update Date | 27/01/2020 |