Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | MD056758L | PA |
NPI | 1225189517 |
---|---|
Provider Name | Scott Franklin Sheppard |
First Address | Carnegie, PA 15106-2404 |
Second Address | Carnegie, PA 15106-2404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G77519 | (02) | PA |