Provider Demographics
NPI:1144529306
Name:SHEPARD, JENNIFER EILEEN (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:EILEEN
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:EILEEN
Other - Last Name:ATKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1510 DIVISION ST
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1581
Mailing Address - Country:US
Mailing Address - Phone:503-905-3400
Mailing Address - Fax:
Practice Address - Street 1:1510 DIVISION ST
Practice Address - Street 2:SUITE 280
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1581
Practice Address - Country:US
Practice Address - Phone:503-905-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-26
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORMD165345208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology