Provider Demographics
NPI:1215928122
Name:SHERMAN, ROSS KELVIN (MD)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:KELVIN
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 1:951 MATTHEW DR
Mailing Address - Street 2:STE A
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-2565
Mailing Address - Country:US
Mailing Address - Phone:601-735-2401
Mailing Address - Fax:601-735-5205
Practice Address - Street 1:951 MATTHEW DR
Practice Address - Street 2:STE A
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2565
Practice Address - Country:US
Practice Address - Phone:601-735-2401
Practice Address - Fax:601-735-5205
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0130196OtherUNITED HEALTHCARE
AL009414840Medicaid
MS00019503Medicaid
ALSHE73071769OtherBLUE CROSS & BLUE SHIELD
AL009414840Medicaid
E90658Medicare UPIN