Healthcare Provider Details

I. General information

NPI: 1083677264
Provider Name (Legal Business Name): RONALD DAVID SHERBERT D. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 N WALDRIP ST
GRAND SALINE TX
75140-1555
US

IV. Provider business mailing address

PO BOX 553 709 N. WALDRIP
GRAND SALINE TX
75140-0553
US

V. Phone/Fax

Practice location:
  • Phone: 903-962-3419
  • Fax: 903-962-3635
Mailing address:
  • Phone: 903-962-3419
  • Fax: 903-962-3635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE3450
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: