Provider Demographics
NPI:1215127832
Name:CHERQUI, ALICE M (MD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:M
Last Name:CHERQUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S CHURCH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4106
Mailing Address - Country:US
Mailing Address - Phone:870-934-1462
Mailing Address - Fax:870-934-1456
Practice Address - Street 1:800 S CHURCH ST STE 201
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-934-1462
Practice Address - Fax:870-934-1456
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-11383208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR229365001Medicaid