Healthcare Provider Details

I. General information

NPI: 1992097059
Provider Name (Legal Business Name): CHERYL C REMIGIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 5TH ST SUITE 100
TYLER TX
75701-3346
US

IV. Provider business mailing address

1000 E 5TH ST SUITE 100
TYLER TX
75701-3346
US

V. Phone/Fax

Practice location:
  • Phone: 903-596-3862
  • Fax: 903-590-5005
Mailing address:
  • Phone: 903-596-3862
  • Fax: 903-590-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39582
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ0550
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: