Provider Demographics
NPI:1013021195
Name:BOCTOR, SHERIEV YOUSRY (DO)
Entity Type:Individual
Prefix:
First Name:SHERIEV
Middle Name:YOUSRY
Last Name:BOCTOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 207012
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7012
Mailing Address - Country:US
Mailing Address - Phone:405-682-3303
Mailing Address - Fax:405-384-6793
Practice Address - Street 1:21212 NORTHWEST FWY STE 425B
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5887
Practice Address - Country:US
Practice Address - Phone:832-756-2976
Practice Address - Fax:346-260-5982
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142810406Medicaid
TX8K8703OtherBCBS
TXH30572Medicare UPIN
TX8A2428Medicare ID - Type Unspecified