Provider Demographics
NPI:1730185497
Name:SHERMAN, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S 336TH STREET
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:1200 COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5838
Practice Address - Country:US
Practice Address - Phone:307-352-8350
Practice Address - Fax:307-352-8178
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043900207P00000X
WY5450A207P00000X
HI12638207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0174377OtherLIWA
WY1730185497Medicaid
WA4968SHOtherBSWA
WA2165SHOtherBSWA
WA8481004Medicaid
WA1186SHOtherBSWA
WA0174392OtherLIWA
WA0174745OtherLIWA
WY110591400Medicaid
WY314488OtherBSWY
F41359Medicare UPIN
WAG8852504Medicare PIN
WY1730185497Medicaid
WA0174745OtherLIWA
WA8481004Medicaid
WA0174392OtherLIWA
WY314488OtherBSWY