Peacock, Robin Ross

Peacock, Robin Ross is an individual health care provider with primary practice located at 2127 Lincoln Ave , Ogden UT 84401-1313. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Peacock, Robin Ross can be contacted via phone (801) 625-3686.

Contact Information

Primary practice address
2127 Lincoln Ave Ogden UT 84401-1313
Phone: (801) 625-3686
Fax: (801) 621-4203
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 138819-6006 Utah

Profile Details

NPI number 1457570277
LBN Legal business name Peacock, Robin Ross
Credentials LSAC
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 24th, 2007
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457570277 NPPES
Utah MEDICAID 876000308007

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