Provider Demographics
NPI:1326014739
Name:SHERK, MARY H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:H
Last Name:SHERK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:P O BOX 122108 DEPT 2108
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-3594
Mailing Address - Country:US
Mailing Address - Phone:337-494-2921
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:1000 WALTERS ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-4647
Practice Address - Country:US
Practice Address - Phone:337-480-8066
Practice Address - Fax:337-480-8109
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2022-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA14581R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMD.14581ROtherSTATE MEDICAL LICENSE
LA1150029Medicaid
4E7097460Medicare PIN
LAH74388Medicare UPIN