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NPI Code Detail

MEDICARE: ROBERT E PEEVY PAC

MEDICARE: ROBERT E PEEVY PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant1143OK

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00731972OTHERMEDICARE RAILROAD

General Provider Information

NPI Number : 1114925245
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT E PEEVY PAC
Provider Business Mailing Address
First Line : 15951 LITTLE AXE DR
Second Line :
City : NORMAN
State : OK
Zip : 73026-9088
Country : US
Telephone Number : 405-447-0300
Fax Number : 405-701-7631
Provider Business Practice Location Address
First Line : 2029 GORDON COOPER DR
Second Line :
City : SHAWNEE
State : OK
Zip : 74801-9005
Country : US
Telephone Number : 405-878-5850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 03/25/2026

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Directions to “ ROBERT E PEEVY PAC” Practice Location

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