Provider Demographics
NPI:1710073879
Name:SHERRIS, KIRK D (DPM)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:D
Last Name:SHERRIS
Suffix:
Gender:M
Credentials:DPM
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 10206
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-0206
Mailing Address - Country:US
Mailing Address - Phone:360-434-0539
Mailing Address - Fax:877-768-9754
Practice Address - Street 1:20730 BOND RD NE STE 120
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9000
Practice Address - Country:US
Practice Address - Phone:360-434-0539
Practice Address - Fax:360-434-0539
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO0000501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1080928Medicaid
WAU39356Medicare UPIN
WA8868131Medicare PIN
WA1080928Medicaid