Provider Demographics
NPI:1275604316
Name:REE, CHERYL R (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:R
Last Name:REE
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:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-636-5680
Mailing Address - Fax:928-636-5853
Practice Address - Street 1:474 N HWY 89
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-5993
Practice Address - Country:US
Practice Address - Phone:928-636-5680
Practice Address - Fax:928-636-5853
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6412207Q00000X
AZ55700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17186Medicaid
AZ440535Medicaid
ND24177Medicare ID - Type Unspecified