Provider Demographics
NPI:1780685685
Name:SHERMA, ARUN D (MD)
Entity Type:Individual
Prefix:
First Name:ARUN
Middle Name:D
Last Name:SHERMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ARUN
Other - Middle Name:
Other - Last Name:DASGUPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3799
Mailing Address - Street 2:
Mailing Address - City:PINETOP
Mailing Address - State:AZ
Mailing Address - Zip Code:85935-3799
Mailing Address - Country:US
Mailing Address - Phone:928-367-9958
Mailing Address - Fax:928-367-9960
Practice Address - Street 1:316 W WHITE MOUNTAIN BLVD
Practice Address - Street 2:STE B
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-7015
Practice Address - Country:US
Practice Address - Phone:928-367-9958
Practice Address - Fax:928-367-9960
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33509207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ919300Medicaid
AZF22678Medicare UPIN
AZZ123197Medicare PIN
AZ103088Medicare ID - Type UnspecifiedPINAL COUNTY
AZ919300Medicaid
AZZ15122Medicare PIN