Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 11168 | TN |
NPI | 1043574114 |
---|---|
Provider Name | Dr. Matthew Sherban |
First Address | Johnson City, TN 37604-2192 |
Second Address | Johnson City, TN 37604-2192 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2012 |
Last Update Date | 20/11/2020 |