Individual
ELIZABETH PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, PHD
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2235
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
82563
GA
207P00000X
Emergency Medicine Physician
Primary
M-16698
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4351043092
MICHIGAN BOARD OF MEDICINE LICENSE NUMBER
MI
01
—
82563
GEORGIA MEDICAL BOARD
GA
Enumeration date
06/20/2016
Last updated
08/19/2022
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