Provider Demographics
NPI:1184922163
Name:PECK, GARY QUINTON (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:QUINTON
Last Name:PECK
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 1:1419 DAUPHINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70116-1924
Mailing Address - Country:US
Mailing Address - Phone:504-949-4939
Mailing Address - Fax:504-944-1946
Practice Address - Street 1:1419 DAUPHINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70116-1924
Practice Address - Country:US
Practice Address - Phone:504-949-4939
Practice Address - Fax:504-944-1946
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.03817R208000000X
ALMD.7555208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics