Provider Demographics
NPI:1871675629
Name:PEAK, SANDRA C (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:C
Last Name:PEAK
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1600 FM 544 STE 100
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-4591
Practice Address - Country:US
Practice Address - Phone:972-316-7400
Practice Address - Fax:972-316-0907
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2094208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166206602Medicaid
TX5539644OtherAETN APIN
TX2917208OtherCIGNA PIN
TX8A9114OtherBCBSTX IND PIN
TX1214722OtherFIRSTHEALTH PIN
TX1819597OtherUHC PIN
TX00U87ZOtherBCBSTX GRP PIN
1750369203OtherGRP NPI NUMBER
TX138454100OtherFIRSTCARE PIN
TX166206602Medicaid
TX00U87ZOtherBCBSTX GRP PIN
TX5539644OtherAETN APIN
TXPEAS452599OtherCCHIP PIN
TX140442884Medicaid
TX8C1669Medicare PIN