Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 5101007453 | MI |
NPI | 1033191242 |
---|---|
Provider Name | Mr. Ronald J Sherman |
First Address | Escanaba, MI 49829 |
Second Address | Escanaba, MI 49829 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 04/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1435503 | (05) | MI |