Provider Demographics
NPI:1073755302
Name:PECK, CARL CURTIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:CURTIS
Last Name:PECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5955 BALM RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-8024
Mailing Address - Country:US
Mailing Address - Phone:805-541-2581
Mailing Address - Fax:805-547-1226
Practice Address - Street 1:5955 BALM RIDGE WAY
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-8024
Practice Address - Country:US
Practice Address - Phone:805-541-2581
Practice Address - Fax:805-547-1226
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19713208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology