MEDICARE: ROGER G PECK MD

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	207R00000X	Internal Medicine Physician	04-20773	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	068002164	OTHER	KS	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1972570331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER G PECK MD

Provider Business Mailing Address
First Line	:	1325 RESEARCH PARK DR
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-5000
Country	:	US
Telephone Number	:	785-537-2651
Fax Number	:	785-270-4347

Provider Business Practice Location Address
First Line	:	1325 RESEARCH PARK DR
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-5000
Country	:	US
Telephone Number	:	785-537-2651
Fax Number	:	785-270-4347

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	12/31/2025

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