MEDICARE: MICHAEL SCOTT PECK DPM

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
1	213E00000X	Podiatrist	POD.0000777	CO
2	213ES0103X	Foot & Ankle Surgery Podiatrist	POD.0000777	CO
3	213E00000X	Podiatrist	251	AR

General Provider Information

NPI Number	:	1770712424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SCOTT PECK DPM

Provider Business Mailing Address
First Line	:	1266 ESCALANTE DR STE 201
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81303-8934
Country	:	US
Telephone Number	:	970-259-5303
Fax Number	:	844-855-6878

Provider Business Practice Location Address
First Line	:	6160 TUTT BLVD STE 250
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-1500
Country	:	US
Telephone Number	:	719-559-3388
Fax Number	:	719-559-3509

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	12/16/2025

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