Provider Demographics
NPI:1861625428
Name:PECK, DEVIN (MD)
Entity type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:
Last Name:PECK
Suffix:
Gender:M
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:PO BOX 674029
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4029
Mailing Address - Country:US
Mailing Address - Phone:512-400-4195
Mailing Address - Fax:512-287-5563
Practice Address - Street 1:1900 SCENIC DR STE 1108
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7724
Practice Address - Country:US
Practice Address - Phone:512-400-4195
Practice Address - Fax:512-287-5563
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246511-1207LP2900X
TXQ2046208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX386506YL5EMedicare PIN
TX386506YL9JMedicare PIN