Provider Demographics
NPI:1194980011
Name:LIBED, CHERRYLL PHOEBE TARUC (MD)
Entity type:Individual
Prefix:DR
First Name:CHERRYLL PHOEBE
Middle Name:TARUC
Last Name:LIBED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHERYLE
Other - Middle Name:PHOEBE
Other - Last Name:LIBED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3016 NADAR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6792
Mailing Address - Country:US
Mailing Address - Phone:817-920-7423
Mailing Address - Fax:
Practice Address - Street 1:4701 BRYANT IRVIN RD. N
Practice Address - Street 2:JPS VIOLA PITTS/COMO
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4917
Practice Address - Country:US
Practice Address - Phone:817-920-7423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0924208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics