MEDICARE: DR. DEAN M SHERRY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	19024	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19024	OTHER	OK	OKLAHOMA LICENSE

General Provider Information

NPI Number	:	1730142324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN M SHERRY M.D.

Provider Business Mailing Address
First Line	:	2408 N COMMERCE ST
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-1356
Country	:	US
Telephone Number	:	580-226-3100
Fax Number	:	580-223-6628

Provider Business Practice Location Address
First Line	:	2408 N COMMERCE ST
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-1356
Country	:	US
Telephone Number	:	580-226-3100
Fax Number	:	580-223-6628

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	07/08/2007

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