Provider Demographics
NPI:1124468277
Name:YU, PENG (MD, PHD)
Entity type:Individual
Prefix:
First Name:PENG
Middle Name:
Last Name:YU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5604 SW LEE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9663
Mailing Address - Country:US
Mailing Address - Phone:580-531-6465
Mailing Address - Fax:580-531-6426
Practice Address - Street 1:5604 SW LEE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9663
Practice Address - Country:US
Practice Address - Phone:580-531-6465
Practice Address - Fax:580-531-6426
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME159414208600000X
MA285974208600000X
TXS5141208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery