Provider Demographics
NPI:1215273131
Name:PEGG, EDWARD W IV (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:W
Last Name:PEGG
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:FAPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801
Mailing Address - Country:US
Mailing Address - Phone:217-383-3311
Mailing Address - Fax:
Practice Address - Street 1:2204 EASTLAND DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3567
Practice Address - Country:US
Practice Address - Phone:309-661-6900
Practice Address - Fax:309-661-6990
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2025-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0361418632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology