Provider Demographics
NPI:1841450913
Name:PEACE, TIMOTHY S (NMD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:S
Last Name:PEACE
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 N 15TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4330
Mailing Address - Country:US
Mailing Address - Phone:602-439-0000
Mailing Address - Fax:602-439-0021
Practice Address - Street 1:7600 N 15TH ST STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4330
Practice Address - Country:US
Practice Address - Phone:602-439-0000
Practice Address - Fax:602-439-0021
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ01664175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath