Provider Demographics
NPI:1831153303
Name:SHERROD, JOHN DENTON (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DENTON
Last Name:SHERROD
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 1:27625 US HIGHWAY 98
Mailing Address - Street 2:BUILDING B
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4816
Mailing Address - Country:US
Mailing Address - Phone:251-300-2300
Mailing Address - Fax:251-300-2301
Practice Address - Street 1:27625 US HIGHWAY 98
Practice Address - Street 2:BUILDING B
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4816
Practice Address - Country:US
Practice Address - Phone:251-300-2300
Practice Address - Fax:251-300-2301
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025334174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1437334026OtherGROUP NPI
AL1437334026OtherGROUP NPI
ALH86774Medicare UPIN