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1811158439

NPI Code Detail

MEDICARE: DR. JEFFREY EDWARD PEACOCK MD

MEDICARE: DR. JEFFREY EDWARD PEACOCK 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	207L00000X	Anesthesiology Physician	2012-00459	NC
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	2012-00459	NC
3	208VP0014X	Interventional Pain Medicine Physician	2012-00459	NC
4	208VP0000X	Pain Medicine Physician	2012-00459	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2012-00459	OTHER	NC	NC MED LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811158439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY EDWARD PEACOCK MD

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	336-277-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 MILLER ST STE I
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27104-4206
Country	:	US
Telephone Number	:	336-277-2225
Fax Number	:	336-227-2231

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

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	03/07/2023

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Directions to “ DR. JEFFREY EDWARD PEACOCK MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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