Provider Demographics
NPI:1538145925
Name:PEYTON, JOSEPH S (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:PEYTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-2826
Mailing Address - Country:US
Mailing Address - Phone:419-794-3026
Mailing Address - Fax:419-794-3006
Practice Address - Street 1:118 E INDIANA AVE
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-2826
Practice Address - Country:US
Practice Address - Phone:419-794-3026
Practice Address - Fax:419-794-3006
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010477207Q00000X
OH4485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000213037OtherANTHEM
OH605424OtherBUCKEYE
OH105181OtherUHC
OH080153823OtherRAILROAD MEDICARE
MI114704202Medicaid
MI14627OtherHEALTH PLAN OF MICHIGAN
OH01973OtherPARAMOUNT
MIJP010447OtherMI BC
OH080139052OtherRAILROAD MEDICARE
MI114719878Medicaid
OHP00185513OtherRAILROAD MEDICARE
OH000000122916OtherANTHEM
OH0698955Medicaid
OH000000122916OtherANTHEM
OH105181OtherUHC
OHP80270Medicare UPIN
MI114704202Medicaid