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General NPI Number Information
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NPI Number | 1558646760
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Entity Type | Individual
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Provider Name | MS. JONISTA M. PEEBLES
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Gender | Female
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 4898 LIVINGSTONE AVE
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City | TROTWOOD
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State | OH
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Zip | 45426-1490
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Country | US
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Telephone | 937-469-7520
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Fax |
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Provider Business Mailing Address
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Address Line | 4898 LINVINGSTONE AVE
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City | DAYTON
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State | OH
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Zip | 45426-0026
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Country | US
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Telephone | 937-469-7520
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 23550895
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 23550895
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23550895
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 23550895
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 23550895
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License Number State | OH
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