Provider Demographics
NPI:1871188284
Name:PEGGS, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:PEGGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 SHUMAKER RD
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-4564
Mailing Address - Country:US
Mailing Address - Phone:304-704-0052
Mailing Address - Fax:
Practice Address - Street 1:365 SHUMAKER RD
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-4564
Practice Address - Country:US
Practice Address - Phone:304-704-0052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker