1750358909 NPI number — MR SHER MD INC

Table of content: (NPI 1750358909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750358909 NPI number — MR SHER MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MR SHER MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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 Information

NPI Number:
1750358909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11200 SEMINOLE BLVD
Provider Second Line Business Mailing Address:
#310
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33778-3239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-397-8557
Provider Business Mailing Address Fax Number:
727-397-4459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11200 SEMINOLE BLVD
Provider Second Line Business Practice Location Address:
#310
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33778-3239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-397-8557
Provider Business Practice Location Address Fax Number:
727-397-4459
Provider Enumeration Date:
03/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHER
Authorized Official First Name:
MANDEL
Authorized Official Middle Name:
REID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-397-8557

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: K3533 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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