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General NPI Number Information
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NPI Number | 1619157054
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Entity Type | Organization
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Legal Business Name | CHERISE A IRBY, MD
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 1801 FAIRFIELD AVE SUITE 103
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City | SHREVEPORT
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State | LA
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Zip | 71101-4443
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Country | US
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Telephone | 318-629-4729
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Fax | 318-629-4730
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Provider Business Mailing Address
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Address Line | 1801 FAIRFIELD AVE SUITE 103
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City | SHREVEPORT
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State | LA
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Zip | 71101-4443
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Country | US
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Telephone | 318-629-4729
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Fax | 318-629-4730
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHERISE A IRBY
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Credential | M.D.
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Telephone | 318-629-4729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 024995
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License Number State | LA
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