Basic Information
| Provider Information | |||||||||
| NPI: | 1538587316 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHERRY | ||||||||
| FirstName: | CASS | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 S UTICA AVE | ||||||||
| Address2: | STE A | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741045346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185995373 | ||||||||
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| Practice Location | |||||||||
| Address1: | 744 W 9TH ST | ||||||||
| Address2: | OSU MEDICAL CENTER GRADUATE MEDICAL EDUCATION | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741279020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185995923 | ||||||||
| FaxNumber: | 9185995949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2014 | ||||||||
| LastUpdateDate: | 07/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 5725 | OK | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 05-38741 | KS | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 2016016167 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.