1730185497 NPI number — JOHN A SHERMAN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730185497 NPI number — JOHN A SHERMAN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SHERMAN

Provider First Name:

JOHN

Provider Middle Name:

A

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1730185497

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/03/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

505 S 336TH STREET

Provider Second Line Business Mailing Address:

SUITE 600

Provider Business Mailing Address City Name:

FEDERAL WAY

Provider Business Mailing Address State Name:

WA

Provider Business Mailing Address Postal Code:

98003-6328

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

253-838-6180

Provider Business Mailing Address Fax Number:

253-838-6418

Provider First Line Business Practice Location Address:

1200 COLLEGE DRIVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ROCK SPRINGS

Provider Business Practice Location Address State Name:

WY

Provider Business Practice Location Address Postal Code:

82901-5838

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

307-352-8350

Provider Business Practice Location Address Fax Number:

307-352-8178

Provider Enumeration Date:

06/27/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207P00000X , with the licence number:  MD00043900 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207P00000X , with the licence number: 5450A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207P00000X , with the licence number: 12638 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 0174377 . This is a "LIWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 1730185497 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
• Identifier: 4968SH . This is a "BSWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 2165SH . This is a "BSWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 8481004 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1186SH . This is a "BSWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 0174392 . This is a "LIWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 0174745 . This is a "LIWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 110591400 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
• Identifier: 314488 . This is a "BSWY" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".