Provider Demographics
NPI:1487833539
Name:BYERS PEAK FAMILY MEDICINE
Entity Type:Organization
Organization Name:BYERS PEAK FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GRAY
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-722-0300
Mailing Address - Street 1:PO BOX 1312
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80482-1312
Mailing Address - Country:US
Mailing Address - Phone:970-722-0300
Mailing Address - Fax:
Practice Address - Street 1:77878 US HIGHWAY 40
Practice Address - Street 2:SUITE 6
Practice Address - City:WINTER PARK
Practice Address - State:CO
Practice Address - Zip Code:80482-1312
Practice Address - Country:US
Practice Address - Phone:970-722-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC802641Medicare PIN