MEDICARE: DR. PETER D. PENG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	ME169728	FL
2	208600000X	Surgery Physician	MD036096	DC
3	208600000X	Surgery Physician	A88562	CA

General Provider Information

NPI Number	:	1710915160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER D. PENG MD

Provider Business Mailing Address
First Line	:	275 W MACARTHUR BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-5641
Country	:	US
Telephone Number	:	510-752-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 N ORANGE AVE STE 201
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4641
Country	:	US
Telephone Number	:	407-821-3620
Fax Number	:	407-821-3621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	10/21/2024

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Directions to “ DR. PETER D. PENG MD” Practice Location

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