Provider Demographics
NPI:1437223054
Name:PEACOCK, JOEL HEWITT LEFEVRE (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:HEWITT LEFEVRE
Last Name:PEACOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1550 S POTOMAC ST
Mailing Address - Street 2:STE 110
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5433
Mailing Address - Country:US
Mailing Address - Phone:303-306-4321
Mailing Address - Fax:720-524-1551
Practice Address - Street 1:12250 E ILIFF AVE
Practice Address - Street 2:#300
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-6318
Practice Address - Country:US
Practice Address - Phone:303-306-4321
Practice Address - Fax:720-524-1551
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO29776207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01297761Medicaid
COCOA104726Medicare PIN
COE97594Medicare UPIN
CO402848Medicare ID - Type Unspecified