Provider Demographics
NPI:1881868008
Name:BALLANTINE-TALMADGE, SHERRIE LYNN (DO)
Entity Type:Individual
Prefix:
First Name:SHERRIE
Middle Name:LYNN
Last Name:BALLANTINE-TALMADGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHERRIE
Other - Middle Name:LYNN
Other - Last Name:BALLANTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2150 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80309-0001
Mailing Address - Country:US
Mailing Address - Phone:303-315-9900
Mailing Address - Fax:
Practice Address - Street 1:2150 STADIUM DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-0001
Practice Address - Country:US
Practice Address - Phone:303-315-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0051809207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine