Provider Demographics
NPI:1073576310
Name:SHERMAN, GENE VICTOR (MD)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:VICTOR
Last Name:SHERMAN
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:PO BOX 2609
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-8609
Mailing Address - Country:US
Mailing Address - Phone:310-568-9595
Mailing Address - Fax:310-568-9595
Practice Address - Street 1:615 N NASH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2825
Practice Address - Country:US
Practice Address - Phone:310-568-9595
Practice Address - Fax:310-568-9595
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36480207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G364800Medicaid
A91788Medicare UPIN
CA00G364800Medicaid