Provider Demographics
NPI:1609304526
Name:PECKAT, WILLIAM MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MATTHEW
Last Name:PECKAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 U OF A WAY
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1419
Mailing Address - Country:US
Mailing Address - Phone:870-779-6000
Mailing Address - Fax:870-779-6093
Practice Address - Street 1:4411 HIGHWAY 5 N
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7005
Practice Address - Country:US
Practice Address - Phone:501-847-0289
Practice Address - Fax:501-847-8748
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-13189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine