Provider Demographics
NPI:1861672537
Name:EUGENE SHERWOOD DPM, INC.
Entity Type:Organization
Organization Name:EUGENE SHERWOOD DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:SHERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:513-829-6332
Mailing Address - Street 1:1260 NILLES RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-7221
Mailing Address - Country:US
Mailing Address - Phone:513-829-6232
Mailing Address - Fax:513-829-8973
Practice Address - Street 1:1260 NILLES RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7221
Practice Address - Country:US
Practice Address - Phone:513-829-6232
Practice Address - Fax:513-829-8973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH36-0020965213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4665390001Medicare NSC
OH9329072Medicare PIN