Provider Demographics
NPI:1740545581
Name:ANDERSON, CHERYL DEBOER (MD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:DEBOER
Last Name:ANDERSON
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 1:3520 W WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2716
Mailing Address - Country:US
Mailing Address - Phone:813-462-3100
Mailing Address - Fax:
Practice Address - Street 1:3520 WEST WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2716
Practice Address - Country:US
Practice Address - Phone:813-462-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN59058208D00000X
GA70250208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice