Healthcare Provider Details

I. General information

NPI: 1821149832
Provider Name (Legal Business Name): RUSSELL LLOYD CHERNE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/14/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E 9TH AVE STE 320
DENVER CO
80220-3922
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 303-322-0212
  • Fax: 303-322-0208
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberCO 1631
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: