Basic Information
| Provider Information | |||||||||
| NPI: | 1295706471 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEN PAS | ||||||||
| FirstName: | SHERRI | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 846098 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752846098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033246450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 E CHARNWOOD ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757011708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035251664 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 10/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 2010-01655 | NC | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | P7042 | TX | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207RS0012X | P7042 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00T71U | 01 | TX | BCBS BLUE | OTHER | P01222503 | 01 | TX | MEDICARE RR | OTHER | 5915940 | 05 | NC | MEDICAID | 752616977002 | 01 | TX | TRICARE | OTHER | 322437002 | 05 | TX | MEDICAID | 752616977001 | 01 | TX | TRICARE | OTHER | 752616977028 | 01 | TX | TRICARE | OTHER | 2403268 | 01 | NC | NC MEDICARE PTAN | OTHER | 75-2616977-026 | 01 | TX | TRICARE | OTHER | NC1289 | 05 | SC | MEDICAID | 322437001 | 05 | TX | MEDICAID | 752616977015 | 01 | TX | TRICARE | OTHER |