Provider Demographics
NPI:1215656129
Name:PEEBLES, RONALD SR
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:PEEBLES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 PALMER ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-5738
Mailing Address - Country:US
Mailing Address - Phone:757-285-0959
Mailing Address - Fax:
Practice Address - Street 1:624 PALMER ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-5738
Practice Address - Country:US
Practice Address - Phone:757-285-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA50947343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)