Provider Demographics
NPI:1982717773
Name:PEAK, DANIEL K JR (MO)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:K
Last Name:PEAK
Suffix:JR
Gender:M
Credentials:MO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8580 MAGELLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 FAIRVIEW DR STE F
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851
Practice Address - Country:US
Practice Address - Phone:757-304-9852
Practice Address - Fax:757-304-3725
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034592207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6013309Medicaid
VA004492OtherBCBS
B07171Medicare UPIN
VA004492OtherBCBS