Provider Demographics
NPI:1477041101
Name:PEAK PLASTIC SURGERY, PLLC
Entity Type:Organization
Organization Name:PEAK PLASTIC SURGERY, PLLC
Other - Org Name:PEAK PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUISINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-702-9191
Mailing Address - Street 1:1055 N 300 W STE 301
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3373
Mailing Address - Country:US
Mailing Address - Phone:801-702-9191
Mailing Address - Fax:801-606-2705
Practice Address - Street 1:1055 N 300 W STE 301
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3373
Practice Address - Country:US
Practice Address - Phone:801-702-9191
Practice Address - Fax:801-606-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-27
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty