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Individual

JAMES EDWARD PEACOCK JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
23418
NC
207RI0200X
Infectious Disease Physician
Primary
23418
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1811158439
VIRGINIA MEDICAID
VA
05
1811158439
NC
01
29170
MEDCOST
01
3699
PARTNERS
01
440003755
RR MEDICARE
01
5282136
AETNA
05
6000286000
WV
05
6026583
VA
01
66361
BCBS
05
8966361
NC
01
NC1806
SC MEDICAID
SC
05
Q23418
SC
Enumeration date
12/13/2005
Last updated
12/18/2014
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