Provider Demographics
NPI:1386634905
Name:CHEEK, BENNIE FRANK (DO)
Entity Type:Individual
Prefix:DR
First Name:BENNIE
Middle Name:FRANK
Last Name:CHEEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:710 E SHAWNTEL SMITH BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MULDROW
Mailing Address - State:OK
Mailing Address - Zip Code:74948-4830
Mailing Address - Country:US
Mailing Address - Phone:918-427-3294
Mailing Address - Fax:918-427-1137
Practice Address - Street 1:710 E SHAWNTEL SMITH BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MULDROW
Practice Address - State:OK
Practice Address - Zip Code:74948
Practice Address - Country:US
Practice Address - Phone:918-427-3294
Practice Address - Fax:918-427-1137
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100077290AMedicaid
OK73-1285295OtherEIN
OK$$$$$$$$$Medicare PIN
OK100077290AMedicaid