Provider Demographics
NPI:1346276235
Name:SHERROD, CHARLES F III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:SHERROD
Suffix:III
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 1:1531 W 32ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1651
Mailing Address - Country:US
Mailing Address - Phone:417-781-3630
Mailing Address - Fax:417-781-9814
Practice Address - Street 1:1531 W 32ND ST STE 102
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1651
Practice Address - Country:US
Practice Address - Phone:417-781-3630
Practice Address - Fax:417-781-9814
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28135207W00000X
LAMD.019476207W00000X
MOR4P23207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100125980AMedicaid
KS100833OtherBC/BS
KS100125980BMedicaid
MO203032107Medicaid
MO23833OtherBC/BS
KS100125980BMedicaid
MO23833OtherBC/BS
MO003011464Medicare PIN
E83491Medicare UPIN
MO180010611Medicare PIN
OK100082830AMedicaid
KS180043263Medicare PIN