Healthcare Provider Details

I. General information

NPI: 1255970265
Provider Name (Legal Business Name): PEAK PLASTIC SURGERY CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E CHERRY CREEK SOUTH DR STE 425
DENVER CO
80246-1518
US

IV. Provider business mailing address

4500 E CHERRY CREEK SOUTH DR STE 425
DENVER CO
80246-1518
US

V. Phone/Fax

Practice location:
  • Phone: 708-689-4770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC BARKER
Title or Position: PRESIDENT
Credential: MD
Phone: 605-876-7653