Provider Demographics
NPI:1215273131
Name:PEGG, EDWARD WILLIAM IV (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WILLIAM
Last Name:PEGG
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17192 E 2450 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:IL
Mailing Address - Zip Code:61748-9235
Mailing Address - Country:US
Mailing Address - Phone:309-531-6164
Mailing Address - Fax:
Practice Address - Street 1:530 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637-0001
Practice Address - Country:US
Practice Address - Phone:309-655-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.0625072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology