Provider Demographics
NPI:1952513962
Name:JEFFREY PEAK MD INC
Entity Type:Organization
Organization Name:JEFFREY PEAK MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-550-0900
Mailing Address - Street 1:PO BOX 5486
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-5486
Mailing Address - Country:US
Mailing Address - Phone:818-550-0900
Mailing Address - Fax:303-953-8260
Practice Address - Street 1:4929 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1702
Practice Address - Country:US
Practice Address - Phone:818-550-0900
Practice Address - Fax:303-953-8260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78221207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G782210Medicaid
CA00G782210OtherBLUE SHIELD
CAG78221Medicare ID - Type Unspecified
CAG38702Medicare UPIN