Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 19004 | SC |
NPI | 1013945906 |
---|---|
Provider Name | John D Sherbert |
First Address | Chattanooga, TN 37422-4686 |
Second Address | Greenville, SC 29601-3955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 01/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
190046 | (05) | SC |
F42867 | (02) |