Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD014980 | LA |
NPI | 1043294069 |
---|---|
Provider Name | Dr. Ivan Sherman |
First Address | San Antonio, TX 78229-5907 |
Second Address | Metarie, LA 70006-2970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 19/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1328308 | (05) | LA |
E48643 | (02) | LA |
H4048Z | BCBS (01) | LA |