Basic Information
| Provider Information | |||||||||
| NPI: | 1467567867 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEELER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9044 FREEMAN OAKS CV | ||||||||
| Address2: | |||||||||
| City: | CORDOVA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380184822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016192068 | ||||||||
| FaxNumber: | 9018210341 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 GETWELL RD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381182205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013698560 | ||||||||
| FaxNumber: | 9013698605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 10/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 15963 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 80124 | 01 | AR | BCBS | OTHER | 114648001 | 05 | AR | MEDICAID | 78133 | 01 | TN | BCBS | OTHER | 00018349 | 05 | MS | MEDICAID | 202529707 | 05 | MO | MEDICAID | Q002122 | 05 | TN | MEDICAID | 3012305 | 05 | TN | MEDICAID |