Provider Demographics
NPI:1982683645
Name:THOMAS, CHERIE ALTA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERIE
Middle Name:ALTA
Last Name:THOMAS
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 1:1003 OLD KINGS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3024
Mailing Address - Country:US
Mailing Address - Phone:386-307-8731
Mailing Address - Fax:
Practice Address - Street 1:890 W 4TH ST
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6437
Practice Address - Country:US
Practice Address - Phone:520-586-3664
Practice Address - Fax:520-586-3486
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33692207P00000X
HIMD-9100207PE0004X
AZ27014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33692OtherWI STATE LIC