Provider Demographics
NPI:1003806159
Name:SHERK, DEREK WILLIAMSON (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:WILLIAMSON
Last Name:SHERK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 HATHAWAY RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3244
Mailing Address - Country:US
Mailing Address - Phone:937-554-8305
Mailing Address - Fax:
Practice Address - Street 1:3077 KETTERING BLVD
Practice Address - Street 2:SUITE NUMBER 319
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45439-1949
Practice Address - Country:US
Practice Address - Phone:937-293-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076965S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine