Provider Demographics
NPI:1083605430
Name:DEMARTELAERE, SHERI LYNN (MD)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:LYNN
Last Name:DEMARTELAERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:L
Other - Last Name:DEMARTELAERE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3551 ROGER BROOKE DR QUALITY SERVICES/7TH FLOOR
Mailing Address - Street 2:BROOKE ARMY MEDICAL CENTER, ATTN: MCHE-ZQQ
Mailing Address - City:JBSA FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-2338
Mailing Address - Fax:
Practice Address - Street 1:3851 ROGER BROOKE DR
Practice Address - Street 2:BROOKE ARMY MEDICAL CENTER, MCHE-QD CREDENTIALS
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4501
Practice Address - Country:US
Practice Address - Phone:210-916-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8321207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167473101Medicaid
TX167473101Medicaid
TX8C1558Medicare ID - Type Unspecified