Provider Demographics
NPI:1497949184
Name:JON R. SHERMAN MD., INC
Entity Type:Organization
Organization Name:JON R. SHERMAN MD., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-578-0533
Mailing Address - Street 1:PO BOX 5664
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92838-0664
Mailing Address - Country:US
Mailing Address - Phone:714-578-0533
Mailing Address - Fax:714-578-0548
Practice Address - Street 1:1400 N HARBOR BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4126
Practice Address - Country:US
Practice Address - Phone:714-578-0533
Practice Address - Fax:714-578-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49871174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF23363Medicare UPIN