Basic Information
Provider Information | |||||||||
NPI: | 1932181468 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PEEBLES | ||||||||
FirstName: | DOUGLAS | ||||||||
MiddleName: | C | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 400 UNION AVE | ||||||||
Address2: |   | ||||||||
City: | FRAMINGHAM | ||||||||
State: | MA | ||||||||
PostalCode: | 017025889 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5088751600 | ||||||||
FaxNumber: | 5088751297 | ||||||||
Practice Location | |||||||||
Address1: | 115 LINCOLN ST | ||||||||
Address2: |   | ||||||||
City: | FRAMINGHAM | ||||||||
State: | MA | ||||||||
PostalCode: | 017026358 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5088751600 | ||||||||
FaxNumber: | 5088751297 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/18/2005 | ||||||||
LastUpdateDate: | 10/30/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 54184 | MA | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 5586023 | 01 | MA | AETNA | OTHER | 613824 | 01 | MA | HARVARD PILGRIM HEALTH CA | OTHER | J17763 | 01 | MA | BLUE CROSS/BLUE SHIELD | OTHER | 3165833 | 05 | MA |   | MEDICAID | 054184 | 01 | MA | TUFTS HEALTHCARE | OTHER | 2000005 | 01 | MA | UNITED HEALTHCARE | OTHER | 82971 | 01 | MA | AETNA US HEALTHCARE | OTHER |