Provider Demographics
NPI:1699891606
Name:SHERMAN, ROBERT OLNEY JR (PA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:OLNEY
Last Name:SHERMAN
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 GRANNYS LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-3510
Mailing Address - Country:US
Mailing Address - Phone:910-695-1262
Mailing Address - Fax:
Practice Address - Street 1:10935 US 15 501 HWY
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387
Practice Address - Country:US
Practice Address - Phone:910-692-5555
Practice Address - Fax:910-692-8581
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103138363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2753006Medicare ID - Type Unspecified