Provider Demographics
NPI:1982698080
Name:WILLIAMS, SHERRY L (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3229 BROADWAY ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-2203
Mailing Address - Country:US
Mailing Address - Phone:541-756-1190
Mailing Address - Fax:541-756-1199
Practice Address - Street 1:3229 BROADWAY ST
Practice Address - Street 2:SUITE D
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2203
Practice Address - Country:US
Practice Address - Phone:541-756-1190
Practice Address - Fax:541-756-1199
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4460213E00000X
ORDP00365213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU94619Medicare UPIN