Provider Demographics
NPI:1720301716
Name:PEAK PERFORMANCE FOOT & ANKLE LLC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE FOOT & ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIC PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:DOMINGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-909-6819
Mailing Address - Street 1:10787 HUNTWICK ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-6992
Mailing Address - Country:US
Mailing Address - Phone:303-880-2093
Mailing Address - Fax:
Practice Address - Street 1:9397 CROWN CREST BLVD
Practice Address - Street 2:SUITE #230
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8575
Practice Address - Country:US
Practice Address - Phone:303-880-2093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO682213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1720301716OtherNPI CORPORATION
CO1720301716OtherPEAK PERFORMANCE FOOT & ANKLE, LLC
COU68075OtherNPI INDIVIDUAL 1962418178
CO6436560001Medicare NSC