Provider Demographics
NPI:1457980260
Name:CHERY, ROCKEFELLER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROCKEFELLER
Middle Name:
Last Name:CHERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 W MILE 3 RD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-1333
Mailing Address - Country:US
Mailing Address - Phone:956-451-9406
Mailing Address - Fax:
Practice Address - Street 1:845 W MILE 3 RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78573-1333
Practice Address - Country:US
Practice Address - Phone:956-451-9406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000421-P.A.363A00000X
TX754523163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant