JONATHAN DALE PECKHAM (NPI# 1992130884) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992130884 |
| Entity Type | Individual |
| Full Name | JONATHAN DALE PECKHAM |
| Credential | PA-C |
| Practice Address |
12361 W Bola Dr Ste 100 Surprise AZ 85378-9021 |
| Mailing Address |
Po Box 41638 Phoenix AZ 85080-1638 |
| Practice Telephone | 6026419486 |
| Practice Fax Number | 4805008430 |
| Mailing Telephone | 6026419486 |
| Mailing Fax Number | 4805008430 |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2020-08-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
5479 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 862609 | 05 |
| Street Address |
12361 W BOLA DR STE 100 |
| City | SURPRISE |
| State | AZ |
| Zip Code | 85378-9021 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003883273 | Teri Victor | Nurse Practitioner | 12361 W Bola Dr Ste 100, Surprise, AZ 85378-9021 | 2006-03-07 |
| 1457989576 | National Cardiovascular Associates, LLC | Internal Medicine | 12361 W Bola Dr Ste 100, Surprise, AZ 85378-9021 | 2020-04-01 |
| 1174160329 | Physician United, LLC | Family Medicine | 12361 W Bola Dr Ste 100, Surprise, AZ 85378-9021 | 2019-12-06 |
| 1114582590 | Gregory David Mikut | Nurse Practitioner | 12361 W Bola Dr Ste 100, Surprise, AZ 85378-9021 | 2019-05-01 |
| 1902312317 | Pinnacle Vein and Vascular Center Pllc | Surgery | 12361 W Bola Dr Ste 100, Surprise, AZ 85378-9021 | 2017-12-20 |
| 1851729776 | Claudia M Angulo | Nurse Practitioner | 12361 W Bola Dr Ste 100, Surprise, AZ 85378-9021 | 2013-10-31 |
| 1063632149 | Stephen Troy Smith | Surgery | 12361 W Bola Dr Ste 100, Surprise, AZ 85378-9021 | 2007-04-30 |
| 1104984491 | Kishlay Anand | Internal Medicine | 12361 W Bola Dr Ste 100, Surprise, AZ 85378-9021 | 2006-12-05 |
| 1982643987 | Annette H Tuszynski | Nurse Practitioner | 12361 W Bola Dr Ste 100, Surprise, AZ 85378-9021 | 2006-06-05 |
| 1295781029 | Andy T Tran | Internal Medicine | 12361 W Bola Dr Ste 100, Surprise, AZ 85378-9021 | 2006-05-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467947101 | Destiny Springs Healthcare, LLC | Psychiatric Hospital | 17300 N. Dysart Road, Surprise, AZ 85378 | 2018-06-26 |
| 1881013480 | Amanda Brimlow | Specialist | 12425 West Bell Rd, Suite 200, Surprise, AZ 85378 | 2014-04-10 |
| 1598193104 | Kalin Marie Harding | Nurse Practitioner | 12425 W. Bell Rd., Suite 106, Suprise, AZ 85378 | 2013-10-16 |
| 1043651540 | Rachel Sara Herrin | Internal Medicine | 12665 W. Smokey Dr., #140, Surprise, AZ 85378 | 2013-07-12 |
| 1962756528 | Daniel Allen Dryer | Registered Nurse | 11607 W. Mingus Mt. Ct., Surprise, AZ 85378 | 2012-11-05 |
| 1124374715 | Rabeca Vatamaniuc | Home Health Aide | 11151 W Lily Mckinley Dr, Surprise, AZ 85378 | 2012-08-01 |
| 1710073457 | Arizona's Children Association | Clinic/Center | 11321 West Bell Road, Suite 401, Surprise, AZ 85378 | 2006-10-04 |
| 1538429121 | Sr Billing | Anesthesiology | 12361 W Bola Dr, Suite 109, Surprise, AZ 85378 | 2012-05-17 |
| 1457515579 | Madhuri Dhupati & Associates Md PC. | Clinic/Center | 12647 W Smokey Dr Ste 119, Surprise, AZ 85378 | 2008-07-17 |
| 1205267119 | Post-acute Physicians of Arizona Pllc | Physical Medicine & Rehabilitation | 13060 W Bell Rd, Surprise, AZ 85378-1200 | 2013-12-02 |
| Find all providers in zip 85378 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275984288 | Ronald West | Physician Assistant | 15126 W Aster Dr, Surprise, AZ 85379-8111 | 2016-06-30 |
| 1912378548 | Whitney Benard | Physician Assistant | 13755 N Litchfield Rd Ste 105, Surprise, AZ 85379-4288 | 2015-10-08 |
| 1891028403 | Brian C Clayton | Physician Assistant | 16345 N 172nd Ln, Surprise, AZ 85388-1222 | 2009-09-14 |
| 1346453487 | Courtney A. Cahill | Physician Assistant | 14239 W. Bell Road, Suite 101, Surprise, AZ 85374 | 2007-05-07 |
| 1700835642 | Johanna M Brooks | Physician Assistant | 14239 West Bell Road, Suite 112, Surprise, AZ 85374-2469 | 2006-05-08 |
| 1346241940 | Nancy J Cooper | Physician Assistant | 14780 W. Mountain View Blvd., Suite 110, Surprise, AZ 85374-7280 | 2005-08-03 |
| 1225590375 | Nayla Mansoor | Physician Assistant | 14674 W Mountain View Blvd Ste 200, Surprise, AZ 85374-2708 | 2019-04-05 |
| 1659854677 | Jay Boardman | Physician Assistant | 13755 N Litchfield Rd Ste 105, Surprise, AZ 85379-4288 | 2018-09-14 |
| 1699222703 | Micaela Hilger | Physician Assistant | 12361 W Bola Dr Ste 109, Surprise, AZ 85378-9021 | 2016-09-07 |
| 1497202584 | Danyelle Dingle | Physician Assistant | 14674 W Mountain View Blvd, Surprise, AZ 85374-2706 | 2016-09-06 |
| Find all providers in SURPRISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.