Healthcare Provider Details

I. General information

NPI: 1699001040
Provider Name (Legal Business Name): DAVID M. PEEPLES MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14825 NORTH OUTER 40 SUITE 330A
CHESTERFIELD MO
63017
US

IV. Provider business mailing address

PO BOX 952629
SAINT LOUIS MO
63195-2629
US

V. Phone/Fax

Practice location:
  • Phone: 636-537-0525
  • Fax: 636-537-0575
Mailing address:
  • Phone: 636-537-0525
  • Fax: 636-537-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberR3L66
License Number StateMO

VIII. Authorized Official

Name: DR. DAVID M PEEPLES
Title or Position: SOLE MEMBER
Credential: MD
Phone: 636-537-0525