Provider Demographics
NPI:1245283472
Name:DORHAUER, CHERI M (MD)
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:M
Last Name:DORHAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHERI
Other - Middle Name:M
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:201 TAHOMA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-7735
Mailing Address - Country:US
Mailing Address - Phone:360-458-7761
Mailing Address - Fax:
Practice Address - Street 1:201 TAHOMA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7735
Practice Address - Country:US
Practice Address - Phone:360-458-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8425977Medicaid
WA0196745OtherL&I
WA5323DOOtherREGENCE
WA0196745OtherL&I
WA5323DOOtherREGENCE