Provider Demographics
NPI:1548218134
Name:SHERRY, RICHARD S (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:SHERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2653 W GUADALUPE ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202
Mailing Address - Country:US
Mailing Address - Phone:480-889-3500
Mailing Address - Fax:480-889-3502
Practice Address - Street 1:4915 E BASELINE RD
Practice Address - Street 2:SUITE 116
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:480-354-9200
Practice Address - Fax:480-354-9201
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ216262085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ470001313OtherRAILROAD MEDICARE
AZAZ0324990OtherBCBS
AZ1Z7049OtherHEALTHNET
AZ138140OtherAHCCCS
AZ138140OtherAHCCCS
AZ1Z7049OtherHEALTHNET
AZZ117691Medicare PIN