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General NPI Number Information
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NPI Number | 1902162167
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Entity Type | Individual
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Provider Name | AMBER CRAIG PEACE DO
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Gender | Female
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Dates
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Enumeration Date | 04/02/2012
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 3504 W CUMBERLAND AVE
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City | MIDDLESBORO
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State | KY
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Zip | 40965
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Country | US
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Telephone | 606-248-0737
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Fax |
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Provider Business Mailing Address
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Address Line | 2333 BIDDLE AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-4668
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Country | US
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Telephone | 606-269-7525
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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 | TP159
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License Number State | KY
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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 | 04227
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License Number State | KY
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