MEDICARE: JOHN SHERRY DPM PLC

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	213EP1101X	Primary Podiatric Medicine Podiatrist	IA00426	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	3715	OTHER	MIDLANDS CHOICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	21735	OTHER	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1336509454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN SHERRY DPM PLC

Provider Business Mailing Address
First Line	:	1505 MALL DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-3111
Country	:	US
Telephone Number	:	319-337-2135
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 MALL DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-3111
Country	:	US
Telephone Number	:	319-337-2135
Fax Number	:

Authorized Official
Title or Position	:	PODIATRIST
Name	:	JOHN SHERRY
Credential	:	DPM
Telephone Number	:	319-331-5194

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	03/02/2016

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