Provider Demographics
NPI:1073591731
Name:PEEBLES, ROOSEVELT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROOSEVELT
Middle Name:
Last Name:PEEBLES
Suffix:JR
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 1:2014 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1910
Mailing Address - Country:US
Mailing Address - Phone:615-320-9300
Mailing Address - Fax:615-320-3065
Practice Address - Street 1:1916 PATTERSON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2192
Practice Address - Country:US
Practice Address - Phone:615-320-9300
Practice Address - Fax:615-320-3065
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD024686208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3079481Medicare ID - Type Unspecified
TNF70157Medicare UPIN