Provider Demographics
NPI:1912056110
Name:YVONNE R S SHERRER MD PA
Entity Type:Organization
Organization Name:YVONNE R S SHERRER MD PA
Other - Org Name:CRIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GLICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-229-7030
Mailing Address - Street 1:5333 N DIXIE HWY
Mailing Address - Street 2:110
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3414
Mailing Address - Country:US
Mailing Address - Phone:954-229-7030
Mailing Address - Fax:954-229-0963
Practice Address - Street 1:5333 N DIXIE HWY
Practice Address - Street 2:110
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3414
Practice Address - Country:US
Practice Address - Phone:954-229-7030
Practice Address - Fax:954-229-0963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047088207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3724Medicare PIN
FLD78869Medicare UPIN