Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 103313 | MO |
NPI | 1073646170 |
---|---|
Provider Name | Robert Wayne Sherrill |
First Address | Jackson, MO 63755-1012 |
Second Address | Cape Girardeau, MO 63703-6393 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |