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General NPI Number Information
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NPI Number | 1235433970
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Entity Type | Organization
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Legal Business Name | RONALD D. SHERBERT, D.O. P.A.
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 709 N WALDRIP ST
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City | GRAND SALINE
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State | TX
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Zip | 75140-1555
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Country | US
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Telephone | 903-962-3419
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Fax | 903-962-3635
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Provider Business Mailing Address
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Address Line | PO BOX 553
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City | GRAND SALINE
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State | TX
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Zip | 75140-0553
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Country | US
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Telephone | 903-962-3419
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Fax | 903-962-3635
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RONALD D SHERBERT
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Credential | D.O.
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Telephone | 903-962-3419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E3450
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License Number State | TX
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