Healthcare Provider Details

I. General information

NPI: 1255127973
Provider Name (Legal Business Name): SHERMAN MD PROVIDER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 JIMMY JOHNSON BLVD STE 500
PORT ARTHUR TX
77640-2007
US

IV. Provider business mailing address

2555 JIMMY JOHNSON BLVD STE 500
PORT ARTHUR TX
77640-2007
US

V. Phone/Fax

Practice location:
  • Phone: 432-254-2433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BURKET
Title or Position: CCO
Credential:
Phone: 818-666-0602