MEDICARE: ADAM G SHERMAN PHD PC

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	103T00000X	Psychologist	771	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	073461769001	OTHER	OK	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1215922042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAM G SHERMAN PHD PC

Provider Business Mailing Address
First Line	:	3015 E SKELLY DR
Second Line	:	SUITE 135
City	:	TULSA
State	:	OK
Zip	:	74105-6317
Country	:	US
Telephone Number	:	918-712-2885
Fax Number	:	918-712-9019

Provider Business Practice Location Address
First Line	:	3015 E SKELLY DR
Second Line	:	SUITE 135
City	:	TULSA
State	:	OK
Zip	:	74105-6317
Country	:	US
Telephone Number	:	918-712-2885
Fax Number	:	918-712-9019

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ADAM GRANT SHERMAN
Credential	:	PHD
Telephone Number	:	918-712-2885

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	11/09/2007

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