Provider Demographics
NPI:1962407502
Name:SHERRY, PAUL DAVID (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:SHERRY
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 1:6011 E WOODMEN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2603
Mailing Address - Country:US
Mailing Address - Phone:719-571-8600
Mailing Address - Fax:719-884-2898
Practice Address - Street 1:6011 E WOODMEN RD STE 105
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2603
Practice Address - Country:US
Practice Address - Phone:719-571-8600
Practice Address - Fax:719-884-2898
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29446207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01294461Medicaid
C458548Medicare ID - Type Unspecified
COCOAAA3639Medicare PIN
CV4698Medicare PIN
CO01294461Medicaid