Individual
MR. CHARLES T SHERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 367-6030
(208) 367-6123
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 367-6030
(208) 367-6123
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA432
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806540800
—
ID
05
—
807782300
—
ID
Enumeration date
06/13/2006
Last updated
05/15/2009
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