Basic Information
| Provider Information | |||||||||
| NPI: | 1003806159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHERK | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | WILLIAMSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1508 HATHAWAY RD | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454193244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375548305 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3077 KETTERING BLVD | ||||||||
| Address2: | SUITE NUMBER 319 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454391949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372932133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 06/21/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35076965S | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.