Provider Demographics
NPI:1427155027
Name:CHEUNG, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:CHEUNG
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 1:1763 W 24TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:928-782-5535
Mailing Address - Fax:928-782-9811
Practice Address - Street 1:1763 W 24TH ST
Practice Address - Street 2:STE 200
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-782-5535
Practice Address - Fax:928-782-9811
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20055208600000X
CAG773692086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0386660OtherBCBS
AZ020046342OtherRAILROAD MEDICARE
AZ165698Medicaid
AZ020046342OtherRAILROAD MEDICARE
AZAZ0386660OtherBCBS