MEDICARE: DR. TODD ALLEN PEAVY MD

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
1	207Q00000X	Family Medicine Physician	024836	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649205956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD ALLEN PEAVY MD

Provider Business Mailing Address
First Line	:	501 DR MICHAEL DEBAKEY DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-5724
Country	:	US
Telephone Number	:	337-475-2252
Fax Number	:	337-475-2253

Provider Business Practice Location Address
First Line	:	1920 W SALE RD
Second Line	:	BLDG F SUITE 1
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-2400
Country	:	US
Telephone Number	:	337-475-2253
Fax Number	:	337-475-2253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	01/30/2017

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Directions to “ DR. TODD ALLEN PEAVY MD” Practice Location

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