Provider Demographics
NPI:1932952389
Name:PEABODY, HENRY NAVARRE IV (DO)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:NAVARRE
Last Name:PEABODY
Suffix:IV
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 W OAK ST STE 5100
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-2155
Mailing Address - Country:US
Mailing Address - Phone:616-267-7668
Mailing Address - Fax:616-754-9883
Practice Address - Street 1:1202 W OAK ST STE 5100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2155
Practice Address - Country:US
Practice Address - Phone:616-267-7668
Practice Address - Fax:616-754-9883
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program