Healthcare Provider Details

I. General information

NPI: 1609304526
Provider Name (Legal Business Name): WILLIAM MATTHEW PECKAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 HIGHWAY 5 N
BRYANT AR
72022-7005
US

IV. Provider business mailing address

3417 U OF A WAY
TEXARKANA AR
71854-1419
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-0289
  • Fax: 501-847-8748
Mailing address:
  • Phone: 870-779-6000
  • Fax: 870-779-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-13189
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: