Provider Demographics
NPI:1871597856
Name:CHEEK, DOUGLAS E (PA-C)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:E
Last Name:CHEEK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 NORTH MAIN
Mailing Address - Street 2:
Mailing Address - City:LOVINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:88260-2830
Mailing Address - Country:US
Mailing Address - Phone:575-396-6611
Mailing Address - Fax:575-396-1454
Practice Address - Street 1:1923 N DAL PASO ST
Practice Address - Street 2:SUITE A
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-3023
Practice Address - Country:US
Practice Address - Phone:575-433-3000
Practice Address - Fax:575-396-1454
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1352363A00000X
NMPA2017-0005363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200038890AMedicaid
OK424760YNU3Medicare PIN
OK424760YNEGMedicare PIN