Provider Demographics
NPI:1891770178
Name:SHERERTZ, ROBERT JACKSON (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JACKSON
Last Name:SHERERTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 CHARLIE HALL BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6099
Mailing Address - Country:US
Mailing Address - Phone:843-402-0227
Mailing Address - Fax:843-402-0232
Practice Address - Street 1:4835 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5037
Practice Address - Country:US
Practice Address - Phone:843-449-1640
Practice Address - Fax:843-449-1605
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34460207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
440003773OtherRR MEDICARE
SCQ23772Medicaid
SCQ23772Medicaid
D57847Medicare UPIN