Provider Demographics
NPI:1659322527
Name:JEWELL, PEGGY LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:LOUISE
Last Name:JEWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PEGGY
Other - Middle Name:LOUISE
Other - Last Name:HASSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2670 DEER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2208
Mailing Address - Country:US
Mailing Address - Phone:405-522-8188
Mailing Address - Fax:
Practice Address - Street 1:1200 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1022
Practice Address - Country:US
Practice Address - Phone:405-522-3879
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK158792084P0800X
AZ315442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E08021Medicare UPIN