Provider Demographics
NPI:1306803077
Name:LAPLANTE, CHERYL CORINNE (DO)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:CORINNE
Last Name:LAPLANTE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:CORINNE
Other - Last Name:TIDBALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:142 S LOUISA RD
Mailing Address - Street 2:
Mailing Address - City:TYGH VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97063-9742
Mailing Address - Country:US
Mailing Address - Phone:541-993-4650
Mailing Address - Fax:
Practice Address - Street 1:505 DESCHUTES AVE
Practice Address - Street 2:
Practice Address - City:MAUPIN
Practice Address - State:OR
Practice Address - Zip Code:97037-7002
Practice Address - Country:US
Practice Address - Phone:541-993-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO19432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR203778Medicaid
OR203778Medicaid
ORG05120Medicare UPIN