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NPI Code Detail

MEDICARE: DR. DOUGLAS L. SHERAM DDS

MEDICARE: DR. DOUGLAS L. SHERAM DDS
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
11223G0001XGeneral Practice Dentistry1540NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1742807354OTHERNMFEDERAL FID NUMBER

General Provider Information

NPI Number : 1902987225
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOUGLAS L. SHERAM DDS
Provider Business Mailing Address
First Line : 4120 BARBARA LOOP SE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87124-1000
Country : US
Telephone Number : 505-892-8086
Fax Number :
Provider Business Practice Location Address
First Line : 4120 BARBARA LOOP SE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87124-1000
Country : US
Telephone Number : 505-892-8086
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 07/08/2007

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