Provider Demographics
NPI:1336241710
Name:NUSSBAUM, SHERRY RENEE (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:RENEE
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SHERRY
Other - Middle Name:RENEE
Other - Last Name:SPICER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1408 W ABRAM ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013
Mailing Address - Country:US
Mailing Address - Phone:817-861-2288
Mailing Address - Fax:817-460-1595
Practice Address - Street 1:1408 W ABRAM ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013
Practice Address - Country:US
Practice Address - Phone:817-861-2288
Practice Address - Fax:817-460-1595
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5853208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I08296Medicare UPIN