Individual provider Active NPI

Connor J Peck, MD

  • Student in an Organized Health Care Education/Training Program
  • Seattle, WA
National Provider Identifier
1104566355
Registry record updated Mar 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
325 9TH Ave # 359796
Seattle, WA 98104-2420
Phone
(385) 226-8680
NPI assigned
Mar 29, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

325 9TH Ave # 359796
Seattle, WA 98104-2420

Mailing address

325 9TH Ave # 359796
Seattle, WA 98104-2420

Other practice location 1

325 9TH Ave. Mail Stop#359796 7TH Floor Center Tower
RM #73.1
Seattle, WA 98104
Phone (206) 744-2826

Other practice location 2

325 9TH Ave. Mail Stop#359796 7TH Floor Center Tower RM
Seattle, WA 98104
Phone (206) 744-2826

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648512000000",
    "number": "1104566355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 9TH AVE # 359796",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981042420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 9TH AVE # 359796",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981042420",
            "telephone_number": "385-226-8680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "325 9TH AVE. MAIL STOP#359796 7TH FLOOR CENTER TOWER",
            "address_2": "RM #73.1",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "98104",
            "country_code": "US",
            "telephone_number": "206-744-2826",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 9TH AVE. MAIL STOP#359796 7TH FLOOR CENTER TOWER RM",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "98104",
            "country_code": "US",
            "telephone_number": "206-744-2826",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PECK",
        "first_name": "CONNOR",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-29",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.