Provider Demographics
NPI:1962408773
Name:PEAK, BRENDA J (DO)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:PEAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:532 MADISON ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4205
Mailing Address - Country:US
Mailing Address - Phone:256-704-7325
Mailing Address - Fax:256-704-7330
Practice Address - Street 1:532 MADISON ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4205
Practice Address - Country:US
Practice Address - Phone:256-704-7325
Practice Address - Fax:256-704-7330
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALDO-337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL52907840Medicaid
AL631119966OtherTAX ID
ALF77172Medicare UPIN
AL52907840Medicaid