Provider Demographics
NPI:1275672065
Name:PEACH, PAMELA D (LM)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:D
Last Name:PEACH
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CARTIER AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-7014
Mailing Address - Country:US
Mailing Address - Phone:321-984-3599
Mailing Address - Fax:321-984-3144
Practice Address - Street 1:209 CARTIER AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-7014
Practice Address - Country:US
Practice Address - Phone:321-984-3599
Practice Address - Fax:321-984-3144
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW84176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife