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NPI Code Detail

MEDICARE: DR. BRUCE WILLIAM PEEK MD

MEDICARE:  DR. BRUCE WILLIAM PEEK  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease Physician14218AZ
2207RI0011XInterventional Cardiology Physician14218AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689776908
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRUCE WILLIAM PEEK MD
Provider Business Mailing Address
First Line : 1200 N BEAVER ST
Second Line : PAYER CREDENTIALING
City : FLAGSTAFF
State : AZ
Zip : 86001-3118
Country : US
Telephone Number : 928-773-2559
Fax Number : 928-213-6292
Provider Business Practice Location Address
First Line : 294 STATE ROUTE 89A
Second Line : SUITE 107
City : COTTONWOOD
State : AZ
Zip : 86326-3763
Country : US
Telephone Number : 928-634-1331
Fax Number : 928-634-3130
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2006
Last Update Date : 01/07/2016

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