Healthcare Provider Details

I. General information

NPI: 1073542825
Provider Name (Legal Business Name): JOSEPH T. SHERREL, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 5TH AVE
MARIANNA FL
32446-2182
US

IV. Provider business mailing address

4316 5TH AVE
MARIANNA FL
32446-2182
US

V. Phone/Fax

Practice location:
  • Phone: 850-526-5437
  • Fax: 850-482-6550
Mailing address:
  • Phone: 850-526-5437
  • Fax: 850-482-6550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME40400
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number40400
License Number StateFL

VIII. Authorized Official

Name: MRS. SANDY BRYANT
Title or Position: OFFICE MANAGER
Credential:
Phone: 850-526-5437