Individual
CLIDE S SHERROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 GOODYEAR BLVD, PICAYUNE, MS 39466-3221
(601) 798-4711
Mailing address
PO BOX 31165, TAMPA, FL 33631-3165
(877) 485-4474
(405) 844-1794
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
14122
MS
207Q00000X
Family Medicine Physician
14122
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114489
—
MS
05
—
1411663
—
LA
05
—
159370001
—
AR
01
—
P00806416
RRMCARE THRU HCCN
MS
Enumeration date
08/12/2006
Last updated
07/06/2010
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