Provider Demographics
NPI:1447521612
Name:CHERYL L ROBERSON MD PA
Entity type:Organization
Organization Name:CHERYL L ROBERSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-615-9400
Mailing Address - Street 1:2352 CREEL LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-4621
Mailing Address - Country:US
Mailing Address - Phone:813-615-9400
Mailing Address - Fax:813-615-9403
Practice Address - Street 1:2352 CREEL LN
Practice Address - Street 2:SUITE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-4621
Practice Address - Country:US
Practice Address - Phone:813-615-9400
Practice Address - Fax:813-615-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67567261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care