Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | H6506 | TX |
N | 207ND0101X | MOHS-Micrographic Surgeon | H6506 | TX |
N | 207ND0900X | Dermatopathologist | H6506 | TX |
N | 207NP0225X | Pediatric Dermatologist | H6506 | TX |
N | 207NS0135X | Procedural Dermatology | H6506 | TX |
NPI | 1336244581 |
---|---|
Provider Name | Dr. Mark Franklin Peake |
First Address | El Paso, TX 79904-1947 |
Second Address | El Paso, TX 79904-1947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I02759 | (02) | TX |