Provider Demographics
NPI:1346265501
Name:PEACE, DONNA JEAN (MD, MSW)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:JEAN
Last Name:PEACE
Suffix:
Gender:F
Credentials:MD, MSW
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Mailing Address - Street 1:PEACE FAMILY MEDICINE, PC
Mailing Address - Street 2:218 W WHITE MOUNTAIN BLVD, STE D
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-0000
Mailing Address - Country:US
Mailing Address - Phone:928-367-9995
Mailing Address - Fax:928-367-9988
Practice Address - Street 1:PEACE FAMILY MEDICINE, PC
Practice Address - Street 2:218 W WHITE MOUNTAIN BLVD, STE D
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-0000
Practice Address - Country:US
Practice Address - Phone:928-367-9995
Practice Address - Fax:928-367-9988
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ31893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ836190Medicaid
AZ8HF219Medicare ID - Type UnspecifiedHSZ158
AZ836190Medicaid
AZ8HF218Medicare ID - Type UnspecifiedHSZ157