Provider Demographics
NPI:1619076767
Name:PEPKA, ALBERT PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:PETER
Last Name:PEPKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16620 N 40TH ST
Mailing Address - Street 2:SUITE B4
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3348
Mailing Address - Country:US
Mailing Address - Phone:602-992-2070
Mailing Address - Fax:602-788-7361
Practice Address - Street 1:16620 N 40TH ST
Practice Address - Street 2:SUITE B4
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3348
Practice Address - Country:US
Practice Address - Phone:602-992-2070
Practice Address - Fax:602-788-7361
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ8286208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD00102Medicare UPIN