Provider Demographics
NPI:1982668125
Name:SHERROD, DUANE WILLARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:WILLARD
Last Name:SHERROD
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 1:520 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3904
Mailing Address - Country:US
Mailing Address - Phone:417-782-3100
Mailing Address - Fax:417-782-2342
Practice Address - Street 1:520 E 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3904
Practice Address - Country:US
Practice Address - Phone:417-782-3100
Practice Address - Fax:417-782-2342
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7D972086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCN5879OtherMEICARE RAILROAD PIN
MOA11945Medicare UPIN
MOCN5879OtherMEICARE RAILROAD PIN