Provider Demographics
NPI:1235192063
Name:CEHAN, E GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:E
Middle Name:GREGORY
Last Name:CEHAN
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 1:615 COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:MEADOW VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95722-9502
Mailing Address - Country:US
Mailing Address - Phone:530-878-0170
Mailing Address - Fax:530-878-9925
Practice Address - Street 1:615 COUNTRY RD
Practice Address - Street 2:
Practice Address - City:MEADOW VISTA
Practice Address - State:CA
Practice Address - Zip Code:95722-9502
Practice Address - Country:US
Practice Address - Phone:530-878-0170
Practice Address - Fax:530-878-9925
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC037091207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C370910Medicaid
CA00C370910Medicare ID - Type Unspecified
CA00C370910Medicaid