Healthcare Provider Details

I. General information

NPI: 1114148160
Provider Name (Legal Business Name): TERESA ANN CHERRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 PROVIDENCE DR
ANCHORAGE AK
99508-4690
US

IV. Provider business mailing address

7525 CHAROLAIS ST
BILLINGS MT
59106-9663
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-2211
  • Fax:
Mailing address:
  • Phone: 970-376-0221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number127269
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME 91219
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36944
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number060-0003414
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: