Provider Demographics
NPI:1386374163
Name:PECKHAM, DEREK (DO)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:PECKHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4855
Mailing Address - Country:US
Mailing Address - Phone:402-483-4571
Mailing Address - Fax:
Practice Address - Street 1:4600 VALLEY RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4855
Practice Address - Country:US
Practice Address - Phone:402-483-4571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program