Provider Demographics
NPI:1831108414
Name:PEAKES, WAVERLY FORD (MD)
Entity Type:Individual
Prefix:MRS
First Name:WAVERLY
Middle Name:FORD
Last Name:PEAKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 2221
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-797-9666
Mailing Address - Fax:713-790-9258
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 2221
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-797-9666
Practice Address - Fax:713-790-9258
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7517174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH99010Medicare UPIN
00U44MMedicare ID - Type Unspecified