Provider Demographics
NPI:1104856749
Name:CHENG, PAUL POWEN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:POWEN
Last Name:CHENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 W RANDOLPH AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-3826
Mailing Address - Country:US
Mailing Address - Phone:580-540-9182
Mailing Address - Fax:580-237-2964
Practice Address - Street 1:723 W RANDOLPH AVE
Practice Address - Street 2:STE 6
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3826
Practice Address - Country:US
Practice Address - Phone:580-540-9182
Practice Address - Fax:580-237-2964
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18914207L00000X, 207KA0200X, 208D00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF93215Medicare UPIN
OKF93215Medicare UPIN