1184658999 NPI number — DR. ROME ABDUL SHERROD III M.D.

Table of content: DR. ROME ABDUL SHERROD III M.D. (NPI 1184658999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184658999 NPI number — DR. ROME ABDUL SHERROD III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERROD
Provider First Name:
ROME
Provider Middle Name:
ABDUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHERROD
Provider Other First Name:
ROME
Provider Other Middle Name:
ABDUL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1184658999
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18451 DOC OLENA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70817-0704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-247-8236
Provider Business Mailing Address Fax Number:
985-626-6136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
73153 MILITARY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70435-6054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-626-6133
Provider Business Practice Location Address Fax Number:
985-626-6136
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  026626 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1058831 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com