Peninsula Surgical Associates, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

0101036761 Issued in VA

Legal business name

PENINSULA SURGICAL ASSOCIATES, INC.

Practice address

4000 Coliseum Dr
Suite 200
Hampton, VA 23666-5906

Phone

(757) 827-2040

Fax

(757) 827-2055

NPI assigned

Nov 13, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. David Leon Gore Jr., M.D.

Title

President

Phone

(757) 827-2040

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720159270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 COLISEUM DR",
            "address_2": "SUITE 200",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236665906",
            "telephone_number": "757-827-2040",
            "fax_number": "757-827-2055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 COLISEUM DR",
            "address_2": "SUITE 200",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236665906",
            "telephone_number": "757-827-2040",
            "fax_number": "757-827-2055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA SURGICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GORE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "LEON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-827-2040",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "VA",
            "license": "0101036761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7301511",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Yanira Perez Rivera, DC
• Ariana Perez
• Jamie Perez, PA-C

• Specialist in Hampton, VA
• Providers in Hampton, VA by specialty
• Specialist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.