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General NPI Number Information
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NPI Number | 1770805673
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Entity Type | Individual
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Provider Name | ADAM THOMAS CHERRY PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 1152 DOUGLAS ST
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City | LONGVIEW
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State | WA
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Zip | 98632-2452
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Country | US
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Telephone | 360-940-0880
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Fax | 844-697-8702
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Provider Business Mailing Address
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Address Line | 43575 MISSION BLVD STE 716
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City | FREMONT
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State | CA
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Zip | 94539-5831
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Country | US
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Telephone | 408-476-0624
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60549062
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License Number State | WA
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