Provider Demographics
NPI:1538177563
Name:PEACO, DAVID E (PHD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:PEACO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MEDICAL DR
Mailing Address - Street 2:STE 205
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385
Mailing Address - Country:US
Mailing Address - Phone:636-332-5050
Mailing Address - Fax:636-327-4723
Practice Address - Street 1:600 MEDICAL DR
Practice Address - Street 2:STE 205
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385
Practice Address - Country:US
Practice Address - Phone:636-332-5050
Practice Address - Fax:636-327-4723
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01175103TC0700X
IL071004359103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
70091Medicare UPIN
MO90001310Medicare ID - Type Unspecified