Provider Demographics
NPI:1649207127
Name:PEACOCK, JAMES LOWRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LOWRY
Last Name:PEACOCK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX SURG
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-8410
Mailing Address - Country:US
Mailing Address - Phone:585-275-1611
Mailing Address - Fax:585-273-1252
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX SURG
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-8410
Practice Address - Country:US
Practice Address - Phone:585-275-1611
Practice Address - Fax:585-273-1252
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-11-01
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Provider Licenses
StateLicense IDTaxonomies
NY1782712086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01135359Medicaid
E16828Medicare UPIN
NY01135359Medicaid