Provider Demographics
NPI:1457514689
Name:PECK, JEREMY WALTER (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:WALTER
Last Name:PECK
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 COLUMBIA POINT DR STE 105
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4390
Mailing Address - Country:US
Mailing Address - Phone:509-873-7140
Mailing Address - Fax:509-818-1303
Practice Address - Street 1:112 COLUMBIA POINT DR STE 105
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4390
Practice Address - Country:US
Practice Address - Phone:509-873-7140
Practice Address - Fax:509-818-1303
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60343797207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology