Provider Demographics
NPI:1073849063
Name:PECK, MELINDA NAOMI (MD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:NAOMI
Last Name:PECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 FILLINGIM ST
Mailing Address - Street 2:MSTN RM 709
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36617-2238
Mailing Address - Country:US
Mailing Address - Phone:251-471-7000
Mailing Address - Fax:251-471-7022
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:MSTN RM 709
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-471-7000
Practice Address - Fax:251-471-7022
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR10434390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program