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General NPI Number Information
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NPI Number | 1750384657
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Entity Type | Individual
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Provider Name | RANDALL J PECK MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 TAYLOR AVE
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City | PEARISBURG
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State | VA
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Zip | 24134-1932
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Country | US
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Telephone | 800-277-8151
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Fax | 336-841-6217
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Provider Business Mailing Address
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Address Line | PO BOX 413
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City | PEARISBURG
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State | VA
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Zip | 24134-0413
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Country | US
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Telephone | 800-277-8151
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Fax | 336-841-6217
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0101038770
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License Number State | VA
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