Provider Demographics
NPI:1508613969
Name:PESCH, SAMUEL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:DAVID
Last Name:PESCH
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 1:28812 N 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-6660
Mailing Address - Country:US
Mailing Address - Phone:562-714-5315
Mailing Address - Fax:
Practice Address - Street 1:940 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3505
Practice Address - Country:US
Practice Address - Phone:509-942-2516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML61546169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine