Provider Demographics
NPI:1902066442
Name:SHEPHERD, DAVID CARLTON (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CARLTON
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 VESSEY RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-3288
Mailing Address - Country:US
Mailing Address - Phone:623-680-0539
Mailing Address - Fax:844-704-5752
Practice Address - Street 1:5550 VESSEY RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-3288
Practice Address - Country:US
Practice Address - Phone:623-680-0539
Practice Address - Fax:844-704-5752
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003266208M00000X
IN02003266A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00886777OtherRAILROAD MEDICARE
IN200908570Medicaid
IN715530CSSSMedicare PIN