Healthcare Provider Details

I. General information

NPI: 1497734909
Provider Name (Legal Business Name): COLIN G SHERRILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 MULLAN RD SUITE C
MISSOULA MT
59808-1811
US

IV. Provider business mailing address

2360 MULLAN RD SUITE C
MISSOULA MT
59808-1811
US

V. Phone/Fax

Practice location:
  • Phone: 406-721-4436
  • Fax: 406-721-6053
Mailing address:
  • Phone: 406-721-4436
  • Fax: 406-721-6053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number9625
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: