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NPI Code Detail

MEDICARE: MR. RICHARD WORTH PECKHAM M.D.

MEDICARE: MR. RICHARD WORTH PECKHAM M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianR3207AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750373395
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICHARD WORTH PECKHAM M.D.
Provider Business Mailing Address
First Line : 412 N VINE
Second Line :
City : MAGNOLIA
State : AR
Zip : 71753-2842
Country : US
Telephone Number : 870-234-7500
Fax Number : 870-234-8225
Provider Business Practice Location Address
First Line : 715 N COLLEGE AVE
Second Line :
City : EL DORADO
State : AR
Zip : 71730-4403
Country : US
Telephone Number : 870-862-7921
Fax Number : 870-864-2490
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2005
Last Update Date : 11/20/2012

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