Provider Demographics
NPI:1568457042
Name:PEAVYHOUSE, JOEL Q (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:Q
Last Name:PEAVYHOUSE
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 1:417 NORTHCREST DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-3973
Mailing Address - Country:US
Mailing Address - Phone:615-382-5204
Mailing Address - Fax:615-382-4952
Practice Address - Street 1:417 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3973
Practice Address - Country:US
Practice Address - Phone:615-382-5204
Practice Address - Fax:615-382-4952
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD6335207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4060714OtherTENNCARE BCBS
TN3165033Medicaid
B03088Medicare UPIN
3165033Medicare ID - Type Unspecified