Individual
CHERYL A FOGARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3103 MCCLELLAND BLVD, JOPLIN, MO 64804-1640
(417) 624-2621
(417) 624-4652
Mailing address
PO BOX 3535, JOPLIN, MO 64803-3535
(417) 624-2621
(417) 624-4652
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
2003008358
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100454900A
—
KS
05
—
100454900B
—
KS
01
—
177853
ANTHEM
MO
05
—
200008560A
—
OK
05
—
200008560B
—
OK
05
—
208438408
—
MO
01
—
P00008391
RR MEDICARE
—
Enumeration date
06/27/2006
Last updated
01/18/2011
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