Healthcare Provider Details

I. General information

NPI: 1871551077
Provider Name (Legal Business Name): LOWELL JAY SHERRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7886 W SAMPLE RD
MARGATE FL
33065-4710
US

IV. Provider business mailing address

7886 W SAMPLE RD
MARGATE FL
33065-4710
US

V. Phone/Fax

Practice location:
  • Phone: 954-752-6465
  • Fax: 954-752-6591
Mailing address:
  • Phone: 954-752-6465
  • Fax: 954-752-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME0034779
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: