Provider Demographics
NPI:1154339752
Name:SHERIDAN, JAMES G (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:SHERIDAN
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 1:425 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-1538
Mailing Address - Country:US
Mailing Address - Phone:870-598-2236
Mailing Address - Fax:870-598-3080
Practice Address - Street 1:425 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-1538
Practice Address - Country:US
Practice Address - Phone:870-598-2236
Practice Address - Fax:870-598-3080
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3095207Q00000X
MOR8C74207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201661709Medicaid
AR101514001Medicaid
AR54801Medicare ID - Type UnspecifiedMEDICARE
ARA11267Medicare UPIN