Healthcare Provider Details

I. General information

NPI: 1780762278
Provider Name (Legal Business Name): PHILLIP A. SHERARD MD.,MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 FOOTHILL BVLD SUITE 200
OAKLAND CA
94605-3429
US

IV. Provider business mailing address

6955 FOOTHILL BVLD SUITE 200
OAKLAND CA
94605-3429
US

V. Phone/Fax

Practice location:
  • Phone: 510-567-5939
  • Fax:
Mailing address:
  • Phone: 510-567-5939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC37385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: