Individual
DR. DALLAS E. PEAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1701 N SENATE BLVD, RM AG0001, INDIANAPOLIS, IN 46202-1239
(317) 962-3886
(317) 962-7086
Mailing address
250 N SHADELAND AVE, STE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01040510
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200061930
—
IN
01
—
930037235
RR MEDICARE
IN
Enumeration date
06/04/2006
Last updated
02/04/2021
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