Provider Demographics
NPI:1134147812
Name:SHERMAN, MARK JASON (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JASON
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:SUITE 660
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1224
Mailing Address - Country:US
Mailing Address - Phone:858-452-5054
Mailing Address - Fax:858-452-5097
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 660
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-452-5054
Practice Address - Fax:858-452-5097
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG69934208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG69934BMedicare PIN
F49111Medicare UPIN