Provider Demographics
NPI:1154315018
Name:PECTOL, RICHARD WESLEY JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:WESLEY
Last Name:PECTOL
Suffix:JR
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 1:223 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-3815
Mailing Address - Country:US
Mailing Address - Phone:423-639-2103
Mailing Address - Fax:423-639-1642
Practice Address - Street 1:223 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-3815
Practice Address - Country:US
Practice Address - Phone:423-639-2103
Practice Address - Fax:423-639-1642
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31786207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3841723Medicaid
TN3841723Medicare PIN
TNG99370Medicare UPIN
TN3841723Medicaid