Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 010126578 | VA |
N | 207QS0010X | Family Doctor - Sports Medicine | 010126578 | VA |
NPI | 1083637292 |
---|---|
Provider Name | John P. Sherrod |
First Address | Midlothian, VA 23112-2107 |
Second Address | Midlothian, VA 23112-2107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 02/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1083637292 | (05) | VA |
B08979 | (02) | |
C06695 | GROUP PTAN (01) | VA |
C09633 | GROUP PTAN (01) | VA |