Provider Demographics
NPI:1669070918
Name:TRI-CITY DERMATOLOGY PLLC
Entity type:Organization
Organization Name:TRI-CITY DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-873-7140
Mailing Address - Street 1:84827 JENNA LN
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-7311
Mailing Address - Country:US
Mailing Address - Phone:484-919-2125
Mailing Address - Fax:509-530-2274
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty