Provider Demographics
NPI:1992097059
Name:REMIGIO, CHERYL C (MD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:C
Last Name:REMIGIO
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 1:1000 E 5TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3346
Mailing Address - Country:US
Mailing Address - Phone:903-596-3862
Mailing Address - Fax:903-590-5005
Practice Address - Street 1:1000 E 5TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3346
Practice Address - Country:US
Practice Address - Phone:903-596-3862
Practice Address - Fax:903-590-5005
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA39582208000000X
TXQ0550208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1992097059Medicaid