MEDICARE: JOEL Q PEAVYHOUSE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	MD6335	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4060714	OTHER	TN	TENNCARE BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568457042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL Q PEAVYHOUSE MD

Provider Business Mailing Address
First Line	:	417 NORTHCREST DR
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3973
Country	:	US
Telephone Number	:	615-382-5204
Fax Number	:	615-382-4952

Provider Business Practice Location Address
First Line	:	417 NORTHCREST DR
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3973
Country	:	US
Telephone Number	:	615-382-5204
Fax Number	:	615-382-4952

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/08/2007

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