Provider Demographics
NPI:1578558086
Name:PEDEN, JAMES G JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:PEDEN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3253
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:521 MOYE BLVD FL 2
Practice Address - Street 2:ECU PHYSICIANS INTERNAL MEDICINE
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2849
Practice Address - Country:US
Practice Address - Phone:252-744-3229
Practice Address - Fax:252-744-3224
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-12-05
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Provider Licenses
StateLicense IDTaxonomies
NC24610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110128302OtherRAILROAD MEDICARE
NC66501OtherBCBS NC
NC8966501Medicaid
NC209486CMedicare PIN
NC66501OtherBCBS NC
NC8966501Medicaid