Provider Demographics
NPI:1235433970
Name:RONALD D. SHERBERT, D.O. P.A.
Entity Type:Organization
Organization Name:RONALD D. SHERBERT, D.O. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHERBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-962-3419
Mailing Address - Street 1:PO BOX 553
Mailing Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099908802Medicaid
TX454237OtherAETNA
TX011539980OtherRAILROAD MEDICARE
TX00R362OtherBLUE CROSS/BLUE SHIELD
TX454237OtherAETNA