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General NPI Number Information
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NPI Number | 1194995423
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Entity Type | Organization
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Legal Business Name | MARK D. PEACOCK MD PC
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 04/05/2010
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Provider Practice Location Address
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Address Line | 16623 BIRKDALE CMNS PKWY SUITE 130
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-5621
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Country | US
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Telephone | 704-896-7005
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Fax | 704-896-7115
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Provider Business Mailing Address
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Address Line | 16623 BIRKDALE CMNS PKWY SUITE 130
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-5621
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Country | US
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Telephone | 704-896-7005
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Fax | 704-896-7115
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK DOUGLAS PEACOCK
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Credential | M.D.
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Telephone | 704-896-7005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 30568
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License Number State | NC
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