Provider Demographics
NPI:1619157054
Name:CHERISE A IRBY, MD
Entity Type:Organization
Organization Name:CHERISE A IRBY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:IRBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-629-4729
Mailing Address - Street 1:1801 FAIRFIELD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4443
Mailing Address - Country:US
Mailing Address - Phone:318-629-4729
Mailing Address - Fax:318-629-4730
Practice Address - Street 1:1801 FAIRFIELD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4443
Practice Address - Country:US
Practice Address - Phone:318-629-4729
Practice Address - Fax:318-629-4730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024995174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0402562OtherUNITED HEALTHCARE
LA1423301Medicaid
LA273431OtherCOVENTRY
LAP00023608OtherRAILROAD MEDICARE
LA7483495OtherAETNA
LA0402562OtherUNITED HEALTHCARE
LA273431OtherCOVENTRY