Provider Demographics
NPI:1992067920
Name:PEACOCK, WARWICK JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:WARWICK
Middle Name:JOHN
Last Name:PEACOCK
Suffix:
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 1:2755 CLARAY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-2016
Mailing Address - Country:US
Mailing Address - Phone:415-259-7850
Mailing Address - Fax:
Practice Address - Street 1:2755 CLARAY DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90077-2016
Practice Address - Country:US
Practice Address - Phone:415-259-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE49023282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital