Provider Demographics
NPI:1376872820
Name:VLECK, JAN PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:PETER
Last Name:VLECK
Suffix:
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 1:3535 7TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5010
Mailing Address - Country:US
Mailing Address - Phone:360-252-2414
Mailing Address - Fax:360-252-2850
Practice Address - Street 1:2415 HERITAGE CT SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6031
Practice Address - Country:US
Practice Address - Phone:360-252-2414
Practice Address - Fax:360-252-2850
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00019601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAE57791Medicare UPIN