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General NPI Number Information
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NPI Number | 1316931702
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Entity Type | Individual
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Provider Name | JON R SHERECK MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 11/26/2019
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Provider Practice Location Address
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Address Line | 107 E OAK AVE
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City | FLAGSTAFF
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State | AZ
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Zip | 86001
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Country | US
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Telephone | 928-779-7880
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Fax | 928-913-8801
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Provider Business Mailing Address
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Address Line | 107 E OAK AVE
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City | FLAGSTAFF
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State | AZ
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Zip | 86001
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Country | US
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Telephone | 928-779-7880
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Fax | 928-913-8801
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | C153955
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 7631
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 23059
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License Number State | NE
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Taxonomy #4
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 59429
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License Number State | AZ
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