Provider Demographics
NPI:1023190527
Name:DARK, SHERI L (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERI
Middle Name:L
Last Name:DARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 BEAUMONT AVENUE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575
Mailing Address - Country:US
Mailing Address - Phone:936-336-6204
Mailing Address - Fax:936-334-1583
Practice Address - Street 1:1409 N TRAVIS ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-3137
Practice Address - Country:US
Practice Address - Phone:936-334-1621
Practice Address - Fax:936-334-1583
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096646701Medicaid
TX096646701Medicaid