Provider Demographics
NPI:1902898950
Name:PECK, ELIZABETH K (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:PECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-8143
Mailing Address - Country:US
Mailing Address - Phone:806-743-2757
Mailing Address - Fax:
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:SUITE 1C143
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-8143
Practice Address - Country:US
Practice Address - Phone:806-743-2757
Practice Address - Fax:806-743-2563
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121233103OtherFIRSTCARE COMMERCIAL
TX139164106Medicaid
NMA206OtherTRIWEST
TX121233102Medicaid
TX139164114Medicaid
NMR9487Medicaid
TX89C626OtherBCBS
TX80729ZOtherHMO BLUE
NM88502Medicaid
OK100146160AMedicaid
NM88502OtherPRESBYTERIAN COMMERCAIL