Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G40133 | CA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | G40133 | CA |
NPI | 1154353050 |
---|---|
Provider Name | Alexander Carlton Sherriffs JR. |
First Address | Fresno, CA 93721-1431 |
Second Address | Fowler, CA 93625-9773 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 09/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A48101 | (02) | CA |