Healthcare Provider Details

I. General information

NPI: 1952369506
Provider Name (Legal Business Name): RICHARD C SHERWOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SULLIVAN AVE STE 402
DALY CITY CA
94015-2228
US

IV. Provider business mailing address

PO BOX 742186
LOS ANGELES CA
90074-2186
US

V. Phone/Fax

Practice location:
  • Phone: 650-992-0400
  • Fax: 650-756-6254
Mailing address:
  • Phone: 650-992-0400
  • Fax: 650-756-6254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG35886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: