Provider Demographics
NPI:1922065085
Name:CHERRY, LILA (MD)
Entity Type:Individual
Prefix:DR
First Name:LILA
Middle Name:
Last Name:CHERRY
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 1:107 MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904
Mailing Address - Country:US
Mailing Address - Phone:936-634-6333
Mailing Address - Fax:936-634-6337
Practice Address - Street 1:107 MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-634-6333
Practice Address - Fax:936-634-6337
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1630208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035724601Medicaid
RK44Medicare ID - Type Unspecified
C14427Medicare UPIN