Provider Demographics
NPI:1821154089
Name:PEAY, CLIFTON L JR (MD)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:L
Last Name:PEAY
Suffix:JR
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:PO BOX 4484
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4484
Mailing Address - Country:US
Mailing Address - Phone:804-559-7002
Mailing Address - Fax:804-559-1921
Practice Address - Street 1:8266 ATLEE RD
Practice Address - Street 2:SUITE 224
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1804
Practice Address - Country:US
Practice Address - Phone:804-559-7002
Practice Address - Fax:804-559-1921
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037406174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist