Provider Demographics
NPI:1699905364
Name:PEABODY, MITCHELL FORD (DO)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:FORD
Last Name:PEABODY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1775 ONE HEALING PL FL 2
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4600
Mailing Address - Country:US
Mailing Address - Phone:850-431-5360
Mailing Address - Fax:850-431-5367
Practice Address - Street 1:1775 ONE HEALING PL FL 2
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4600
Practice Address - Country:US
Practice Address - Phone:850-431-5360
Practice Address - Fax:850-431-5367
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101018509207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine