Basic Information
| Provider Information | |||||||||
| NPI: | 1477041101 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PEAK PLASTIC SURGERY, PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PEAK PROSTHETICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 N 300 W STE 301 | ||||||||
| Address2: | |||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017029191 | ||||||||
| FaxNumber: | 8016062705 | ||||||||
| Practice Location | |||||||||
| Address1: | 1055 N 300 W STE 301 | ||||||||
| Address2: | |||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017029191 | ||||||||
| FaxNumber: | 8016062705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2018 | ||||||||
| LastUpdateDate: | 04/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | SHERIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUISINESS OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8017029191 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.