Provider Demographics
NPI:1063495356
Name:CHERRY, DEBORAH A (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:A
Last Name:CHERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 S HIGUERA ST STE 701
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7742
Mailing Address - Country:US
Mailing Address - Phone:805-439-1381
Mailing Address - Fax:805-439-0138
Practice Address - Street 1:4251 S HIGUERA ST STE 701
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7742
Practice Address - Country:US
Practice Address - Phone:805-439-1381
Practice Address - Fax:805-439-0138
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61844207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G618440OtherBLUE SHIELD LEGACY PIN
CA00G618440OtherBLUE SHIELD OF CA PIN
ORR004OtherSLO SELECT
CA05D0996840OtherCLIA
1109232696OtherRAILROAD MEDICARE
635978OtherFIRST HEALTH LEGACY PIN
CA00G618440OtherBLUE SHIELD LEGACY PIN
635978OtherFIRST HEALTH LEGACY PIN