Basic Information
| Provider Information | |||||||||
| NPI: | 1629056916 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHERMAN | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13737 NOEL RD STE 1600 | ||||||||
| Address2: | ATTN RAYS | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752401374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039338270 | ||||||||
| FaxNumber: | 2147122002 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 BERGQUIST DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | LACKLAND AFB | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782369908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102925133 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 05/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | L3822 | TX | N | Other Service Providers | Military Health Care Provider | 2085R0202X | ME98490 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | L3822 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 3153300 | 05 | FL | MEDICAID | L3822 | 01 | TX | MEDICAL LICENSE | OTHER | E-6140 | 01 | AR | MEDICAL LICENSE | OTHER | ME98490 | 01 | FL | MEDICAL LICENSE | OTHER |