Provider Demographics
NPI:1285670752
Name:PEACOCK, JOHN HOLLIS (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HOLLIS
Last Name:PEACOCK
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LOCUST ST
Mailing Address - Street 2:VA111
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2597
Mailing Address - Country:US
Mailing Address - Phone:775-328-1297
Mailing Address - Fax:775-328-1768
Practice Address - Street 1:1000 LOCUST ST
Practice Address - Street 2:VA111
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2597
Practice Address - Country:US
Practice Address - Phone:775-328-1297
Practice Address - Fax:775-328-1768
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV40572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN406OtherSPINAL CORD INJURY MED
NV20-16928Medicaid
MN20909OtherNEUROLOGY
MN337OtherVASCULAR NEUROLOGY
NV20-16928Medicaid