Provider Demographics
NPI:1144851148
Name:CHERRY, ROBERT (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CHERRY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 GLEN OAK ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6132
Mailing Address - Country:US
Mailing Address - Phone:860-324-0136
Mailing Address - Fax:
Practice Address - Street 1:320 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-8819
Practice Address - Country:US
Practice Address - Phone:319-626-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant