Provider Demographics
NPI:1821149832
Name:CHERNE, RUSSELL LLOYD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:LLOYD
Last Name:CHERNE
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:10900 W 44TH AVE UNIT 200
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2742
Mailing Address - Country:US
Mailing Address - Phone:720-923-1239
Mailing Address - Fax:303-284-4082
Practice Address - Street 1:7862 W MANSFIELD PKWY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-1934
Practice Address - Country:US
Practice Address - Phone:303-987-4546
Practice Address - Fax:303-987-4547
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2019-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COCO 1631363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant