Provider Demographics
NPI:1861493389
Name:PEABODY, BRENDA KAY (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:PEABODY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 73627
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77273-3627
Mailing Address - Country:US
Mailing Address - Phone:281-444-3278
Mailing Address - Fax:832-249-3861
Practice Address - Street 1:17350 ST LUKES WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4167
Practice Address - Country:US
Practice Address - Phone:281-444-3278
Practice Address - Fax:832-249-3861
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH8316207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127667707Medicaid
TX127667707Medicaid
TXE73260Medicare UPIN