Provider Demographics
NPI:1467567867
Name:PEELER, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:PEELER
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 1:9044 FREEMAN OAKS CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4822
Mailing Address - Country:US
Mailing Address - Phone:901-619-2068
Mailing Address - Fax:901-821-0341
Practice Address - Street 1:3000 GETWELL RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-2205
Practice Address - Country:US
Practice Address - Phone:901-369-8560
Practice Address - Fax:901-369-8605
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN159632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR80124OtherBCBS
AR114648001Medicaid
TN78133OtherBCBS
MS00018349Medicaid
MO202529707Medicaid
TNQ002122Medicaid
TN3012305Medicaid
MS00018349Medicaid
TN3012305Medicaid
A97636Medicare UPIN
MS300000502Medicare ID - Type Unspecified