Healthcare Provider Details

I. General information

NPI: 1811211766
Provider Name (Legal Business Name): VICTOR L SHERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 CIELO AZUL ST
SANTA FE NM
87501-1607
US

IV. Provider business mailing address

1029 CIELO AZUL ST
SANTA FE NM
87501-1607
US

V. Phone/Fax

Practice location:
  • Phone: 214-923-1550
  • Fax: 707-988-7359
Mailing address:
  • Phone: 214-923-1550
  • Fax: 707-988-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2010-0587
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: