1346265501 NPI number — DR. DONNA JEAN PEACE MD, MSW

Table of content: DR. DONNA JEAN PEACE MD, MSW (NPI 1346265501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346265501 NPI number — DR. DONNA JEAN PEACE MD, MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEACE
Provider First Name:
DONNA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346265501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PEACE FAMILY MEDICINE, PC
Provider Second Line Business Mailing Address:
218 W WHITE MOUNTAIN BLVD, STE D
Provider Business Mailing Address City Name:
LAKESIDE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85929-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-367-9995
Provider Business Mailing Address Fax Number:
928-367-9988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PEACE FAMILY MEDICINE, PC
Provider Second Line Business Practice Location Address:
218 W WHITE MOUNTAIN BLVD, STE D
Provider Business Practice Location Address City Name:
LAKESIDE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85929-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-367-9995
Provider Business Practice Location Address Fax Number:
928-367-9988
Provider Enumeration Date:
07/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  31893 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 836190 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".