Provider Demographics
NPI:1235172644
Name:BROWN, SHERRI L (MD)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4857
Mailing Address - Country:US
Mailing Address - Phone:208-459-7415
Mailing Address - Fax:208-453-3200
Practice Address - Street 1:315 E ELM ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4857
Practice Address - Country:US
Practice Address - Phone:208-459-7415
Practice Address - Fax:208-453-3200
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7234207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID804217900Medicaid
ID804217900Medicaid
ID1137283Medicare ID - Type Unspecified