Provider Demographics
NPI:1033271317
Name:PEAVY, DONALD R (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:PEAVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66455
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-6455
Mailing Address - Country:US
Mailing Address - Phone:225-927-0180
Mailing Address - Fax:225-926-3803
Practice Address - Street 1:4848 NORTH BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4019
Practice Address - Country:US
Practice Address - Phone:225-927-0180
Practice Address - Fax:225-926-3803
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1918199Medicaid
E56730Medicare UPIN
LA1918199Medicaid