Provider Demographics
NPI:1295706471
Name:TEN PAS, SHERRI L (DO)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:L
Last Name:TEN PAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:120 E CHARNWOOD ST
Practice Address - Street 2:SUITE B
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1708
Practice Address - Country:US
Practice Address - Phone:903-525-1664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP70422084N0400X, 207RS0012X, 207T00000X
NC2010-01655207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-026OtherTRICARE
TX752616977001OtherTRICARE
SCNC1289Medicaid
TX752616977015OtherTRICARE
NC2403268OtherNC MEDICARE PTAN
TX752616977028OtherTRICARE
TX00T71UOtherBCBS BLUE
NC5915940Medicaid
TX752616977002OtherTRICARE
TXP01222503OtherMEDICARE RR
TX322437001Medicaid
TX322437002Medicaid
TX752616977028OtherTRICARE