Provider Demographics
NPI:1881763613
Name:PEACOCK, JOHN EDWARD III (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:PEACOCK
Suffix:III
Gender:M
Credentials:DO
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Mailing Address - Street 1:10000 SHANNONDELL DR
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-5615
Mailing Address - Country:US
Mailing Address - Phone:610-728-5241
Mailing Address - Fax:610-728-5322
Practice Address - Street 1:10000 SHANNONDELL DR
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:PA
Practice Address - Zip Code:19403-5615
Practice Address - Country:US
Practice Address - Phone:610-728-5241
Practice Address - Fax:610-728-5322
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2014-06-03
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Provider Licenses
StateLicense IDTaxonomies
PAOS014770207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine