Provider Demographics
NPI:1306071345
Name:SHERMAN, BETH MARIE (IDMT)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:MARIE
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 D ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3744
Mailing Address - Country:US
Mailing Address - Phone:671-988-5615
Mailing Address - Fax:
Practice Address - Street 1:36 MDOS/SGOAF
Practice Address - Street 2:UNIT 14010
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96543-4010
Practice Address - Country:US
Practice Address - Phone:315-366-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians