Provider Demographics
NPI:1053569640
Name:SHEPHERD, SCOTT THOMAS (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:THOMAS
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:PO BOX 740020
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0020
Mailing Address - Country:US
Mailing Address - Phone:127-339-7303
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:1538 N LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74110-2535
Practice Address - Country:US
Practice Address - Phone:918-400-7001
Practice Address - Fax:539-202-5070
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK02234208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics