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General NPI Number Information
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NPI Number | 1558866392
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Entity Type | Individual
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Provider Name | STEPHEN HUNT PEACOCK MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | WALTER REED NATIONAL MILITARY MEDICAL CENTER 4494 PALMER RD N
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City | BETHESDA
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State | MD
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Zip | 20814
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Country | US
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Telephone | 252-314-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 4494 PALMER RD N 4494 PALMER RD N
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City | BETHESDA
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State | MD
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Zip | 20814
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Country | US
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Telephone |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 2019-01904
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License Number State | NC
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