Basic Information
| Provider Information | |||||||||
| NPI: | 1114970704 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHERWOOD | ||||||||
| FirstName: | CHAD | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 SHEPHERD DR | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721436873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012686831 | ||||||||
| FaxNumber: | 5012792402 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 SHEPHERD DR | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721436873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012686831 | ||||||||
| FaxNumber: | 5012792402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 02/06/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | E-2666 | AR | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | E-2666 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 140930001 | 05 | AR | MEDICAID |