Healthcare Provider Details

I. General information

NPI: 1619076767
Provider Name (Legal Business Name): ALBERT PETER PEPKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16620 N 40TH ST SUITE B4
PHOENIX AZ
85032-3348
US

IV. Provider business mailing address

16620 N 40TH ST SUITE B4
PHOENIX AZ
85032-3348
US

V. Phone/Fax

Practice location:
  • Phone: 602-992-2070
  • Fax: 602-788-7361
Mailing address:
  • Phone: 602-992-2070
  • Fax: 602-788-7361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8286
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: