Healthcare Provider Details

I. General information

NPI: 1437223054
Provider Name (Legal Business Name): JOEL HEWITT LEFEVRE PEACOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 E ILIFF AVE #300
AURORA CO
80014-6318
US

IV. Provider business mailing address

1550 S POTOMAC ST STE 110
AURORA CO
80012-5433
US

V. Phone/Fax

Practice location:
  • Phone: 303-306-4321
  • Fax: 720-524-1551
Mailing address:
  • Phone: 303-306-4321
  • Fax: 720-524-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number29776
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: