Provider Demographics
NPI:1225145279
Name:PEEBLES, FRED NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:NEAL
Last Name:PEEBLES
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:DEPT 888067
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-8067
Mailing Address - Country:US
Mailing Address - Phone:865-588-8838
Mailing Address - Fax:865-584-7712
Practice Address - Street 1:7557 DANNAHER WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849
Practice Address - Country:US
Practice Address - Phone:865-938-8121
Practice Address - Fax:865-212-5561
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD6687208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3172263Medicaid
TN3172263Medicaid
TNB03519Medicare UPIN