Basic Information
Provider Information
NPI: 1457503625
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHERER
FirstName: TRAVIS
MiddleName: PAUL
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 130 SUTTER ST FL 2
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941044009
CountryCode: US
TelephoneNumber: 4156586791
FaxNumber:  
Practice Location
Address1: 2 EMBARCADERO CTR LBBY LEVEL
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 94111
CountryCode: US
TelephoneNumber: 4155783100
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/18/2008
LastUpdateDate: 02/11/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700X012837NYN Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
363A00000X53822CAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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