Peck, Wallace W

Peck, Wallace W is an individual health care provider with primary practice located at One Hoag Drive , Newport Beach CA 92663-4162. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neuroradiology, Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Peck, Wallace W can be contacted via phone (949) 764-5570.

Contact Information

Primary practice address
One Hoag Drive Newport Beach CA 92663-4162
Phone: (949) 764-5570
Fax: (949) 263-0473
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neuroradiology 2085N0700X G52810 California
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X G52810 California
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X G52810 California

Profile Details

NPI number 1508810367
LBN Legal business name Peck, Wallace W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 19th, 2006
Last updated Dec 19th, 2007 - about 17 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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1508810367 NPPES
California Other 00G528100 BLUE SHIELD
California MEDICAID 00G528100 BLUE SHIELD

Popular Providers