Provider Demographics
NPI:1457339103
Name:SHERROD, JESSE A III (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:A
Last Name:SHERROD
Suffix:III
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 1:8906 SPANISH RIDGE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1319
Mailing Address - Country:US
Mailing Address - Phone:702-330-3102
Mailing Address - Fax:702-912-4994
Practice Address - Street 1:8906 SPANISH RIDGE AVE STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1319
Practice Address - Country:US
Practice Address - Phone:702-330-3102
Practice Address - Fax:702-912-4994
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6325207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCS06312OtherPHARMACY/CDS
NV002018337Medicaid
NVBS2993473OtherDEA
NVB63056Medicare UPIN
NVWQBHV36516Medicare ID - Type Unspecified