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General NPI Number Information
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NPI Number | 1912205840
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Entity Type | Individual
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Provider Name | CHARLES A PECK MD
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Gender | Male
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Dates
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Enumeration Date | 03/01/2011
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 10901 W 120TH AVE
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City | BROOMFIELD
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State | CO
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Zip | 80021-3418
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Country | US
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Telephone | 720-304-8941
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Fax |
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Provider Business Mailing Address
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Address Line | 2872 GEMINI LOOP
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City | BROOMFIELD
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State | CO
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Zip | 80023-4678
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Country | US
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Telephone | 650-515-6301
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Fax |
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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 | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | MD432063
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License Number State | PA
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