Individual
PENNY JEAN PEACOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1612 UTE BLVD, 205, PARK CITY, UT 84098-7500
(435) 655-3309
(435) 655-3392
Mailing address
1612 UTE BLVD, 205, PARK CITY, UT 84098-7500
(435) 655-3309
(435) 655-3392
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
3764531205
UT
208000000X
Pediatrics Physician
3764531205
UT
208M00000X
Hospitalist Physician
3764531205
UT
Other
Enumeration date
05/02/2006
Last updated
05/16/2013
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