Provider Demographics
NPI:1568801629
Name:SPACEK-LLANAS, SHERRY CELETE (MD)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:CELETE
Last Name:SPACEK-LLANAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 848476
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8476
Mailing Address - Country:US
Mailing Address - Phone:254-202-4655
Mailing Address - Fax:254-202-4697
Practice Address - Street 1:7300 BOSQUE BLVD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4023
Practice Address - Country:US
Practice Address - Phone:254-202-2600
Practice Address - Fax:254-202-2650
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10047967207Q00000X
TXQ5282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine