Provider Demographics
NPI:1073595831
Name:SHERMAN, JOHN L (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
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 1:69 W BOULDER ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3371
Mailing Address - Country:US
Mailing Address - Phone:719-389-1106
Mailing Address - Fax:719-389-1180
Practice Address - Street 1:69 W BOULDER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3371
Practice Address - Country:US
Practice Address - Phone:719-389-1106
Practice Address - Fax:719-389-1180
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO307842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1307842Medicaid
CO1307842Medicaid
C174818Medicare PIN