Healthcare Provider Details

I. General information

NPI: 1548465404
Provider Name (Legal Business Name): CHERRA FAYE PUMPHREY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13137 SORRENTO RD
PENSACOLA FL
32507-8777
US

IV. Provider business mailing address

1005 MAR WALT DRIVE
FORT WALTON BEACH FL
32547-3900
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-0020
  • Fax:
Mailing address:
  • Phone: 850-863-8202
  • Fax: 850-862-6148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME101944
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: