Provider Demographics
NPI:1205925344
Name:SHERWOOD, LORAN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:LORAN
Middle Name:DAVID
Last Name:SHERWOOD
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:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81432-0270
Mailing Address - Country:US
Mailing Address - Phone:970-626-5123
Mailing Address - Fax:970-626-9783
Practice Address - Street 1:570 PALOMINO TRL
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:CO
Practice Address - Zip Code:81432-9246
Practice Address - Country:US
Practice Address - Phone:970-626-5123
Practice Address - Fax:970-626-9783
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01353762Medicaid
CO841554989002OtherROCKY MOUNTAIN
COSH39676OtherBLUE CROSS BLUE SHIELD
CO841554989002OtherROCKY MOUNTAIN
COF01443Medicare UPIN