MEDICARE: CLIDE S SHERROD MD

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	207P00000X	Emergency Medicine Physician	14122	MS
2	207Q00000X	Family Medicine Physician	14122	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P00806416	OTHER	MS	RRMCARE THRU HCCN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942212543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIDE S SHERROD MD

Provider Business Mailing Address
First Line	:	PO BOX 31165
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33631-3165
Country	:	US
Telephone Number	:	877-485-4474
Fax Number	:	405-844-1794

Provider Business Practice Location Address
First Line	:	801 GOODYEAR BLVD
Second Line	:
City	:	PICAYUNE
State	:	MS
Zip	:	39466-3221
Country	:	US
Telephone Number	:	601-798-4711
Fax Number	:

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/06/2010

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Directions to “ CLIDE S SHERROD MD” Practice Location

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