Provider Demographics
NPI:1164446985
Name:PECK, REBECCA DAVIS (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:DAVIS
Last Name:PECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:FAY
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3009 N BALLAS RD
Mailing Address - Street 2:STE. 208B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2322
Mailing Address - Country:US
Mailing Address - Phone:314-994-0200
Mailing Address - Fax:314-994-7945
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:STE. 208B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-994-0200
Practice Address - Fax:314-994-7945
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100609174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist