Provider Demographics
NPI:1184658999
Name:SHERROD, ROME ABDUL III (MD)
Entity type:Individual
Prefix:DR
First Name:ROME
Middle Name:ABDUL
Last Name:SHERROD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROME
Other - Middle Name:ABDUL
Other - Last Name:SHERROD
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:18451 DOC OLENA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-0704
Mailing Address - Country:US
Mailing Address - Phone:225-247-8236
Mailing Address - Fax:985-626-6136
Practice Address - Street 1:73153 MILITARY RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435-6054
Practice Address - Country:US
Practice Address - Phone:985-626-6133
Practice Address - Fax:985-626-6136
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA026626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1058831Medicaid
LAI19973Medicare UPIN