Provider Demographics
NPI:1205803970
Name:PETERSON, CHERI A (DO)
Entity type:Individual
Prefix:DR
First Name:CHERI
Middle Name:A
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:CHERI
Other - Middle Name:A
Other - Last Name:AFLLEJE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT(ASCP)
Mailing Address - Street 1:101 S MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-5047
Mailing Address - Country:US
Mailing Address - Phone:918-342-6200
Mailing Address - Fax:918-342-6409
Practice Address - Street 1:101 S MOORE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5047
Practice Address - Country:US
Practice Address - Phone:918-342-6200
Practice Address - Fax:918-342-6409
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999137391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1999137391OtherMISSOURI STATE LICENSE NUMBER
MO1999137391OtherMISSOURI STATE LICENSE NUMBER