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NPI Code Detail

MEDICARE: DR. JOHN EDWARD PEACOCK III D.O.

MEDICARE: DR. JOHN EDWARD PEACOCK III D.O.
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
1207QG0300XGeriatric Medicine (Family Medicine) PhysicianOS014770PA
2207Q00000XFamily Medicine PhysicianOS014770PA

General Provider Information

NPI Number : 1881763613
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN EDWARD PEACOCK III D.O.
Provider Business Mailing Address
First Line : 10000 SHANNONDELL DR
Second Line :
City : AUDUBON
State : PA
Zip : 19403-5615
Country : US
Telephone Number : 610-728-5241
Fax Number : 610-728-5322
Provider Business Practice Location Address
First Line : 10000 SHANNONDELL DR
Second Line :
City : AUDUBON
State : PA
Zip : 19403-5615
Country : US
Telephone Number : 610-728-5241
Fax Number : 610-728-5322
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2006
Last Update Date : 06/03/2014

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Directions to “ DR. JOHN EDWARD PEACOCK III D.O.” Practice Location

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