Healthcare Provider Details

I. General information

NPI: 1043294069
Provider Name (Legal Business Name): IVAN SHERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 HOUMA BLVD EMERGENCY ROOM
METARIE LA
70006-2970
US

IV. Provider business mailing address

8401 DATAPOINT DR SUITE 500
SAN ANTONIO TX
78229-5907
US

V. Phone/Fax

Practice location:
  • Phone: 504-456-5428
  • Fax:
Mailing address:
  • Phone: 210-614-0180
  • Fax: 210-614-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD014980
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: