Healthcare Provider Details

I. General information

NPI: 1942216940
Provider Name (Legal Business Name): MATTHEW J SHERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 ALTON PKWY ALTON/SAND CANYON MOB2
IRVINE CA
92618-3734
US

IV. Provider business mailing address

441 N LAKEVIEW AVE
ANAHEIM CA
92807-3028
US

V. Phone/Fax

Practice location:
  • Phone: 949-932-2250
  • Fax: 949-932-6353
Mailing address:
  • Phone: 949-932-2250
  • Fax: 949-932-6353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01064106A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA105092
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036109655
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number01064106A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA105092
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number036109655
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: