Healthcare Provider Details

I. General information

NPI: 1851408058
Provider Name (Legal Business Name): PIERCE MCCAMMON SHERRILL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PETER MCCAMMON SHERRILL

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 VOYAGER DRIVE
GREEN BAY WI
54311
US

IV. Provider business mailing address

3237 VOYAGER DR
GREEN BAY WI
54311-8349
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-8100
  • Fax: 920-468-3114
Mailing address:
  • Phone: 920-288-8100
  • Fax: 920-468-3114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number26489
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number26489
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: