Provider Demographics
NPI:1104886514
Name:SHERMAN, STANLEY ROBERT (DO)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:ROBERT
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:STAN
Other - Middle Name:R
Other - Last Name:SHERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:101 S PARK LN
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-5731
Mailing Address - Country:US
Mailing Address - Phone:580-379-6180
Mailing Address - Fax:580-379-6189
Practice Address - Street 1:101 S PARK LN
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-5731
Practice Address - Country:US
Practice Address - Phone:580-379-6180
Practice Address - Fax:580-379-6189
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3491208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100120140AMedicaid
FLFM692ZMedicare PIN