Provider Demographics
NPI:1699799379
Name:LIAO, PEGGY (MD)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3770
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-1440
Mailing Address - Country:US
Mailing Address - Phone:303-805-7686
Mailing Address - Fax:303-805-7732
Practice Address - Street 1:2200 E 18TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1205
Practice Address - Country:US
Practice Address - Phone:303-322-7789
Practice Address - Fax:303-805-7732
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43533207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85558052Medicaid
CO016756OtherKAISER COMMERCIAL NUMBER
COCOA102569Medicare PIN
COI35878Medicare UPIN
COC802520Medicare PIN
CO85558052Medicaid
COCOAAA2300Medicare PIN