Provider Demographics
NPI:1194130823
Name:PEAK NEUROLOGY AND SLEEP MEDICINE, LLC
Entity type:Organization
Organization Name:PEAK NEUROLOGY AND SLEEP MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-695-4537
Mailing Address - Street 1:2741 DEBARR RD STE C308
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2972
Mailing Address - Country:US
Mailing Address - Phone:907-331-3640
Mailing Address - Fax:907-348-7574
Practice Address - Street 1:2741 DEBARR RD STE C308
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-331-3640
Practice Address - Fax:907-348-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10020729261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1616451Medicaid
1194130823OtherNPI