Provider Demographics
NPI:1306808316
Name:SHERBURN, ERIC W (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:W
Last Name:SHERBURN
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:PO BOX 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-619-4400
Mailing Address - Fax:918-619-4662
Practice Address - Street 1:5005 S DARLINGTON AVE # 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7307
Practice Address - Country:US
Practice Address - Phone:918-619-4400
Practice Address - Fax:918-619-4662
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21448207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100136580BMedicaid
OK100136580BMedicaid
OKG44090Medicare UPIN
OK140006944OtherRAILROAD MEDICARE
OK100136580AMedicaid