Healthcare Provider Details

I. General information

NPI: 1124483169
Provider Name (Legal Business Name): ALEX SHERRY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 11/21/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 GOLF COURSE RD NW
ALBUQUERQUE NM
87120-5842
US

IV. Provider business mailing address

46 E 15TH ST
EDMOND OK
73013-4301
US

V. Phone/Fax

Practice location:
  • Phone: 505-800-7070
  • Fax:
Mailing address:
  • Phone: 405-200-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2593
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: