Provider Demographics
NPI:1326024415
Name:CLAGG, SHERMAN
Entity Type:Individual
Prefix:
First Name:SHERMAN
Middle Name:
Last Name:CLAGG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 GAFFNEY RD #7440
Mailing Address - Street 2:COMMANDER, USA-MEDDAC-AK, ATTN:MCUC-MMD-Q
Mailing Address - City:FT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-7440
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1060 GAFFNEY RD #7440
Practice Address - Street 2:COMMANDER, USA-MEDDAC-AK, ATTN:MCUC-MMD-Q
Practice Address - City:FT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-7440
Practice Address - Country:US
Practice Address - Phone:907-353-5418
Practice Address - Fax:907-353-4845
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX619561163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse