Provider Demographics
NPI:1376501692
Name:SHEPHERD, KURTE WALLY (DPM)
Entity type:Individual
Prefix:DR
First Name:KURTE
Middle Name:WALLY
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10223 BROADWAY ST STE P246
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7880
Mailing Address - Country:US
Mailing Address - Phone:832-539-1620
Mailing Address - Fax:832-539-1621
Practice Address - Street 1:4501 CARTWRIGHT RD
Practice Address - Street 2:SUITE 208
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3534
Practice Address - Country:US
Practice Address - Phone:832-539-1620
Practice Address - Fax:832-539-1621
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1563213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5143640001OtherDMERC
0035HWOtherBCBS
TX1529075002Medicaid
0035HWOtherBCBS
TX00511PMedicare PIN
TX00S11PMedicare ID - Type Unspecified