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General NPI Number Information
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NPI Number | 1619452364
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Entity Type | Organization
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Legal Business Name | PEAK INTERNAL MEDICINE
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Dates
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Enumeration Date | 09/28/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 400 S MCCASLIN BLVD STE 200
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City | LOUISVILLE
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State | CO
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Zip | 80027-9701
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Country | US
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Telephone | 720-222-0648
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Fax | 720-222-0654
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Provider Business Mailing Address
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Address Line | 400 S MCCASLIN BLVD STE 200
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City | SUPERIOR
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State | CO
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Zip | 80027-9701
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Country | US
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Telephone | 720-222-0648
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Fax | 720-222-0654
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER TAMBLYN
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Credential | MD
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Telephone | 720-272-9112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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