Healthcare Provider Details

I. General information

NPI: 1477932515
Provider Name (Legal Business Name): CHENG FANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR STE 381
OCOEE FL
34761-3435
US

IV. Provider business mailing address

10000 W COLONIAL DR STE 381
OCOEE FL
34761-3435
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-3467
  • Fax: 407-253-2563
Mailing address:
  • Phone: 321-841-3467
  • Fax: 407-253-2563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number21391
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME133590
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME133590
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: