Healthcare Provider Details

I. General information

NPI: 1457506669
Provider Name (Legal Business Name): RANDY LYNN SHERBON SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CLERMONT ST
DENVER CO
80220-3808
US

IV. Provider business mailing address

1055 CLERMONT ST
DENVER CO
80220
US

V. Phone/Fax

Practice location:
  • Phone: 303-393-4633
  • Fax: 303-393-4685
Mailing address:
  • Phone: 303-393-4633
  • Fax: 303-393-4685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: