Provider Demographics
NPI:1073363669
Name:PEACOCK, PAXTON WADE (MD, MBA)
Entity Type:Individual
Prefix:
First Name:PAXTON
Middle Name:WADE
Last Name:PEACOCK
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE STREET
Mailing Address - Street 2:ANESTHESIOLOGY N202
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-323-5956
Mailing Address - Fax:859-323-1080
Practice Address - Street 1:800 ROSE STREET
Practice Address - Street 2:ANESTHESIOLOGY N202
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-323-5956
Practice Address - Fax:859-323-1080
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program