Doctor Name: | SHEPPARD PENG |
NPI Number: | 1376962035 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | 741852963 |
Business Practice Address: | 206 2nd St E Bradenton, FL - 342081042 |
Business Phone Number: | 9417465111 |
Business Fax Number: | |
Mailing Address: | 4802 51st St W, #1013 BRADENTON |
State: | FL |
Postal Code: | 342105101 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/10/2014 |
NPI Last Update Date: | 05/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 741852963 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |