Provider Demographics
NPI:1225234032
Name:KETHA, CHERADY JANE (DO)
Entity Type:Individual
Prefix:DR
First Name:CHERADY
Middle Name:JANE
Last Name:KETHA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHERADY
Other - Middle Name:JANE
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3815 S. VAL VISTA DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7309
Mailing Address - Country:US
Mailing Address - Phone:480-782-0993
Mailing Address - Fax:855-329-8939
Practice Address - Street 1:7787 W DEER VALLEY RD STE 296
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2119
Practice Address - Country:US
Practice Address - Phone:602-978-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007016632207V00000X
AZ006623207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology