Provider Demographics
NPI:1699490078
Name:PEACOCK, CHEA Z (RT (R) (M)/CPT)
Entity type:Individual
Prefix:
First Name:CHEA
Middle Name:Z
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:RT (R) (M)/CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7533 KRYPTON DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3140
Mailing Address - Country:US
Mailing Address - Phone:252-308-3215
Mailing Address - Fax:
Practice Address - Street 1:7533 KRYPTON DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3140
Practice Address - Country:US
Practice Address - Phone:252-308-3215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXGMR020100742085R0202X
TXNPCN-16623-1949246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXGMR02010074OtherR.T (R)