Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101-236464 | VA |
Y | 2080P0214X | Pediatric Pulmonologist | 0101-236464 | VA |
NPI | 1487626388 |
---|---|
Provider Name | James Sherman |
First Address | Roanoke, VA 24013-2254 |
Second Address | Roanoke, VA 24013-2256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 11/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010072581 | (05) | VA |
D53960 | (02) | VA |