Basic Information
| Provider Information | |||||||||
| NPI: | 1861672537 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EUGENE SHERWOOD DPM, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1260 NILLES RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450147221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138296232 | ||||||||
| FaxNumber: | 5138298973 | ||||||||
| Practice Location | |||||||||
| Address1: | 1260 NILLES RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450147221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138296232 | ||||||||
| FaxNumber: | 5138298973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2007 | ||||||||
| LastUpdateDate: | 08/31/2009 | ||||||||
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| AuthorizedOfficialLastName: | SHERWOOD | ||||||||
| AuthorizedOfficialFirstName: | EUGENE | ||||||||
| AuthorizedOfficialMiddleName: | FRANK | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5138296332 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | OH36-0020965 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.