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General NPI Number Information
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NPI Number | 1669730396
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Entity Type | Organization
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Legal Business Name | ROOSEVELT PEEBLES, JR., MD, PC
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 05/01/2012
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Provider Practice Location Address
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Address Line | 1916 PATTERSON ST SUITE 205
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City | NASHVILLE
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State | TN
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Zip | 37203-2120
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Country | US
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Telephone | 615-320-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 1916 PATTERSON ST SUITE 205
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City | NASHVILLE
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State | TN
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Zip | 37203-2120
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Country | US
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Telephone | 615-320-9300
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ROOSEVELT PEEBLES JR.
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Credential | MD
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Telephone | 615-320-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | MD00024686
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License Number State | TN
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