Healthcare Provider Details

I. General information

NPI: 1346307063
Provider Name (Legal Business Name): RUFUS W. PEEBLES ED. D., J. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 GREAT PLAINS ROAD
WEST TISBURY MA
02575-0338
US

IV. Provider business mailing address

PO BOX 338
WEST TISBURY MA
02575-0338
US

V. Phone/Fax

Practice location:
  • Phone: 508-693-5100
  • Fax: 508-693-3147
Mailing address:
  • Phone: 508-693-5100
  • Fax: 508-693-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3558
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: