Provider Demographics
NPI:1346265501
Name:PEACE ELLIOTT, DONNA JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:JEAN
Last Name:PEACE ELLIOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:J
Other - Last Name:PEACE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:TUBA CITY REGIONAL HEALTHCARE CORPORATION
Mailing Address - Street 2:167 N MAIN ST
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045
Mailing Address - Country:US
Mailing Address - Phone:866-976-5941
Mailing Address - Fax:928-367-9988
Practice Address - Street 1:TUBA CITY REGIONAL HEALTHCARE CORPORATION
Practice Address - Street 2:167 N MAIN ST
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045
Practice Address - Country:US
Practice Address - Phone:866-976-5941
Practice Address - Fax:928-367-9988
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ836190Medicaid
AZ8HF219Medicare ID - Type UnspecifiedHSZ158
AZ836190Medicaid
AZ8HF218Medicare ID - Type UnspecifiedHSZ157