Provider Demographics
NPI:1255768362
Name:PEELER, JOSEPH GLENN JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GLENN
Last Name:PEELER
Suffix:JR
Gender:
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 470
Mailing Address - Street 2:
Mailing Address - City:SHAW
Mailing Address - State:MS
Mailing Address - Zip Code:38773-0470
Mailing Address - Country:US
Mailing Address - Phone:662-754-6151
Mailing Address - Fax:
Practice Address - Street 1:311 DEAN BLVD.
Practice Address - Street 2:
Practice Address - City:SHAW
Practice Address - State:MS
Practice Address - Zip Code:38773-0470
Practice Address - Country:US
Practice Address - Phone:662-754-6151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSB66050Medicare UPIN