MEDICARE: DR. DEREK WILLIAMSON SHERK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35076965S	OH

General Provider Information

NPI Number	:	1003806159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEREK WILLIAMSON SHERK MD

Provider Business Mailing Address
First Line	:	1508 HATHAWAY RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-3244
Country	:	US
Telephone Number	:	937-554-8305
Fax Number	:

Provider Business Practice Location Address
First Line	:	3077 KETTERING BLVD
Second Line	:	SUITE NUMBER 319
City	:	DAYTON
State	:	OH
Zip	:	45439-1949
Country	:	US
Telephone Number	:	937-293-2133
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	06/21/2012

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