Individual
EVAN R PECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
525 OKEECHOBEE BLVD, 14TH FLOOR, WEST PALM BEACH, FL 33401-6349
(561) 804-0200
(561) 804-0222
Mailing address
525 OKEECHOBEE BLVD, 14TH FLOOR, WEST PALM BEACH, FL 33401-6349
(561) 804-0200
(561) 804-0222
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
104554
MN
208100000X
Physical Medicine & Rehabilitation Physician
52325
MN
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
ME 106449
FL
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
Enumeration date
11/02/2008
Last updated
07/08/2010
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