Provider Demographics
NPI:1083677264
Name:SHERBERT, RONALD DAVID (D O)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DAVID
Last Name:SHERBERT
Suffix:
Gender:M
Credentials:D O
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 553
Mailing Address - Street 2:709 N. WALDRIP
Mailing Address - City:GRAND SALINE
Mailing Address - State:TX
Mailing Address - Zip Code:75140-0553
Mailing Address - Country:US
Mailing Address - Phone:903-962-3419
Mailing Address - Fax:903-962-3635
Practice Address - Street 1:709 N WALDRIP ST
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140-1555
Practice Address - Country:US
Practice Address - Phone:903-962-3419
Practice Address - Fax:903-962-3635
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099908802Medicaid
TX099908802Medicaid
TXD97701Medicare UPIN