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General NPI Number Information
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NPI Number | 1417263534
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Entity Type | Organization
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Legal Business Name | GEORGE H PEACOCK MD PC
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 804 E NAVAJO ST
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City | FARMINGTON
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State | NM
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Zip | 87401-9119
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Country | US
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Telephone | 505-947-6359
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Fax | 505-326-2773
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Provider Business Mailing Address
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Address Line | 804 E NAVAJO ST
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City | FARMINGTON
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State | NM
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Zip | 87401-9119
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Country | US
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Telephone | 505-947-6359
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Fax | 505-326-2773
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Authorized Official
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Title or Position | OFFICE MANANGER
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Name | DARLA SANTILLANES
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Credential |
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Telephone | 505-947-6359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 76-82
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License Number State | NM
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