Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | G78221 | CA |
NPI | 1003954355 |
---|---|
Provider Name | Jeffery C Peak |
First Address | Orange, CA 92863-5486 |
Second Address | Sherman Oaks, CA 91403-1702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 24/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G782210 | (05) | CA |
G38702 | (02) | CA |