Provider Demographics
NPI:1710968896
Name:SHERRY, JOHN P (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:SHERRY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:P
Other - Last Name:SHERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1505 MALL DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-3111
Mailing Address - Country:US
Mailing Address - Phone:319-337-2135
Mailing Address - Fax:319-337-3061
Practice Address - Street 1:1505 MALL DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-3111
Practice Address - Country:US
Practice Address - Phone:319-337-2135
Practice Address - Fax:319-337-3061
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA00426213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0217356Medicaid
IA21735OtherBLUE CROSS BLUE SHIELD
IA3715OtherMIDLANDS CHOICE
IA3715OtherMIDLANDS CHOICE
IAT01227Medicare UPIN
IA5535730001Medicare NSC