JONATHAN DALE PECKHAM PA-C NPI 1992130884

NPI Information

NPI: 1992130884
Provider Name: JONATHAN DALE PECKHAM, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: NATIONAL CARDIOVASCULAR ASSOCIATES, LLC

PECOS Registration: Yes

Address:
12361 W BOLA DR STE 100
SURPRISE, AZ
ZIP 85378
Phone: (602) 641-9486
Get Directions

Jonathan Dale Peckham, PA-C is a medical physician assistant in Surprise, AZ with 11 years of experience. Jonathan Dale Peckham, PA-C NPI is 1992130884. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

12361 W BOLA DR STE 100
SURPRISE, AZ
ZIP 85378-021
Phone: (602) 641-9486
Fax: (480) 500-8430

The NPI 1992130884 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/10/2013 and was last updated on 8/27/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	5479	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	862609	MEDICAID	ARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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