Provider Demographics
NPI:1639246044
Name:PORTWOOD, CHERYL C (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:C
Last Name:PORTWOOD
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 1:315 MAIN ST.
Mailing Address - Street 2:SUITE 6-12
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520
Mailing Address - Country:US
Mailing Address - Phone:307-332-4515
Mailing Address - Fax:307-332-4899
Practice Address - Street 1:315 MAIN ST.
Practice Address - Street 2:SUITE 6-12
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520
Practice Address - Country:US
Practice Address - Phone:307-332-4515
Practice Address - Fax:307-332-4899
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6499A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY6499AOtherBOARD OF MEDICINE
WY6499AOtherBOARD OF MEDICINE