Individual
MR. JEFFREY FRANK PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
650 JOEL DR, FT. CAMPBELL, KY, FORT CAMPBELL, KY 42223-5318
(270) 798-8106
(279) 956-0180
Mailing address
650 JOEL DR, FT. CAMPBELL BACH, FORT CAMPBELL, KY 42223-5318
(270) 798-8106
(279) 956-0180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1084990
TX
363AM0700X
Medical Physician Assistant
Primary
1084990
TN
Other
Enumeration date
09/30/2008
Last updated
09/30/2008
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