Provider Demographics
NPI:1770509184
Name:PENG, YONG GANG (MD)
Entity Type:Individual
Prefix:DR
First Name:YONG GANG
Middle Name:
Last Name:PENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YONG GANG
Other - Middle Name:
Other - Last Name:PENG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 100254
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0254
Mailing Address - Country:US
Mailing Address - Phone:352-265-0077
Mailing Address - Fax:352-265-6922
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0254
Practice Address - Country:US
Practice Address - Phone:352-265-0077
Practice Address - Fax:352-265-6922
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81868207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264357000Medicaid
FL13095ZMedicare PIN
FL264357000Medicaid