Healthcare Provider Details

I. General information

NPI: 1992719066
Provider Name (Legal Business Name): EDWARD J SHERWOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N I H 35 9D3
AUSTIN TX
78701-4318
US

IV. Provider business mailing address

40 N I H 35 9D3
AUSTIN TX
78701-4318
US

V. Phone/Fax

Practice location:
  • Phone: 512-343-8070
  • Fax: 512-342-9949
Mailing address:
  • Phone: 512-343-8070
  • Fax: 512-342-9949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberF5372
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: