Basic Information
Provider Information | |||||||||
NPI: | 1407276538 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PEAVLER | ||||||||
FirstName: | CASEY | ||||||||
MiddleName: | BRETT | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 12951 NW 1ST ST APT 205 | ||||||||
Address2: |   | ||||||||
City: | PEMBROKE PINES | ||||||||
State: | FL | ||||||||
PostalCode: | 330283205 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3058493806 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 911 BYPASS RD BLDG A | ||||||||
Address2: |   | ||||||||
City: | PIKEVILLE | ||||||||
State: | KY | ||||||||
PostalCode: | 415011689 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6062183500 | ||||||||
FaxNumber: | 6062184697 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/16/2014 | ||||||||
LastUpdateDate: | 10/21/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/21/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01078920A | IN | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 53258 | KY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 01078920A | IN | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 207R00000X | ME129299 | FL | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.