Provider Demographics
NPI:1205827565
Name:SHERWOOD, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:SHERWOOD
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 1:127 CRESTVIEW PARK DR STE 209
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2856
Mailing Address - Country:US
Mailing Address - Phone:615-446-5121
Mailing Address - Fax:615-446-1357
Practice Address - Street 1:2340 FAIRVIEW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062-9458
Practice Address - Country:US
Practice Address - Phone:629-205-3018
Practice Address - Fax:629-205-3020
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4946207Q00000X
TN57869207Q00000X
MO2006013854207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163658001Medicaid
AR5N726OtherAR BLUE SHIELD #
MOP00374551OtherRR MDCR #
ARP00374552OtherRR MEDICARE
MO201789906Medicaid
TNQ037511Medicaid
MO5N726OtherAR BLUE SHIELD #
TNQ037511Medicaid
NCH84296Medicare UPIN
MO961453230Medicare PIN
MOP00374551OtherRR MDCR #