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General NPI Number Information
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NPI Number | 1710915160
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Entity Type | Individual
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Provider Name | PETER D. PENG MD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 2501 N ORANGE AVE STE 201
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City | ORLANDO
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State | FL
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Zip | 32804-4641
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Country | US
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Telephone | 407-821-3620
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Fax | 407-821-3621
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Provider Business Mailing Address
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Address Line | 275 W MACARTHUR BLVD
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City | OAKLAND
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State | CA
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Zip | 94611-5641
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Country | US
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Telephone | 510-752-1000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME169728
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD036096
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A88562
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License Number State | CA
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