Healthcare Provider Details

I. General information

NPI: 1861555989
Provider Name (Legal Business Name): MICHAEL C. PEACE, D.O.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E ADKINS ST
SEAGOVILLE TX
75159-2801
US

IV. Provider business mailing address

103 E ADKINS ST
SEAGOVILLE TX
75159-2801
US

V. Phone/Fax

Practice location:
  • Phone: 972-287-7187
  • Fax: 972-287-6493
Mailing address:
  • Phone: 972-287-7187
  • Fax: 972-287-6493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberH6504
License Number StateTX

VIII. Authorized Official

Name: DR. MICHAEL C PEACE
Title or Position: PHYSICIAN
Credential: DO
Phone: 972-287-7187