Peck, Jason Russell
Peck, Jason Russell is an individual health care provider with primary practice located at 9 Richland Medical Park Dr Ste 530 , Columbia SC 29203-6870. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine. Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine is his primary health care specialty. Peck, Jason Russell can be contacted via phone (803) 434-4603.Contact Information
Primary practice address
9 Richland Medical Park Dr Ste 530
Columbia SC 29203-6870
Phone: (803) 434-4603
Fax: (803) 434-3866
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 33116 | South Carolina |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | L8471 | Texas |
| Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine | 2080P0203X | 45451 | Colorado |
| Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine | 2080P0203X | 33116 | South Carolina |
Profile Details
| NPI number | 1235290693 |
|---|---|
| LBN Legal business name | Peck, Jason Russell |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 12th, 2006 |
| Last updated | Mar 23rd, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1235290693 | NPPES |
| South Carolina | MEDICAID | 31162 |
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