Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A107107 | CA |
N | 208200000X | Surgeon | MD60595416 | WA |
N | 208600000X | Surgeon | MD60595416 | WA |
N | 2086S0129X | Vascular Surgeon | 4301103957 | MI |
N | 2086S0129X | Vascular Surgeon | MD455337 | PA |
N | 2086S0129X | Vascular Surgeon | MD60595416 | WA |
NPI | 1255536090 |
---|---|
Provider Name | Dr. Sherry Lee Cavanagh |
First Address | Fresno, CA 93701-2302 |
Second Address | Fresno, CA 93701-2302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 24/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103050626 | (05) | PA |