Provider Demographics
NPI:1477551158
Name:SHERMAN, ROGER S (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:S
Last Name:SHERMAN
Suffix:
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:PO BOX 1850
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-1850
Mailing Address - Country:US
Mailing Address - Phone:970-349-0321
Mailing Address - Fax:970-349-0328
Practice Address - Street 1:214 6TH ST
Practice Address - Street 2:
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224-1850
Practice Address - Country:US
Practice Address - Phone:970-349-0321
Practice Address - Fax:970-349-0328
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30833207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01308337Medicaid
COB70055Medicare UPIN
CO496998Medicare ID - Type Unspecified
COCB5164Medicare UPIN