Basic Information
| Provider Information | |||||||||
| NPI: | 1982683645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | CHERIE | ||||||||
| MiddleName: | ALTA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1003 OLD KINGS RD | ||||||||
| Address2: | |||||||||
| City: | HOLLY HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321173024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3863078731 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 890 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | BENSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856026437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205863664 | ||||||||
| FaxNumber: | 5205863486 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 33692 | WI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PE0004X | MD-9100 | HI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207Q00000X | 27014 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 33692 | 01 | WI | WI STATE LIC | OTHER |