Healthcare Provider Details

I. General information

NPI: 1871601328
Provider Name (Legal Business Name): WARREN GARY SHERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: W GARY SHERMAN M.D.

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 NORTH NEW BALLAS ROAD SUITE 206
ST. LOUIS MO
63141-6819
US

IV. Provider business mailing address

522 NORTH NEW BALLAS ROAD SUITE 206
ST. LOUIS MO
63141-6819
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-0707
  • Fax: 314-994-9046
Mailing address:
  • Phone: 314-569-0707
  • Fax: 314-994-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR4595
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: