PECKS FAMILY PRACTICE PLC
Marriage and Family Therapists at Granada Blvd, Ormond Beach, FL

License number
Florida ME71672
Category
Osteopathic Medicine
Type
Family Medicine
Owner
Name: BENJAMIN JAY PECK MD
Title: OWNER
Phone: (386) 677-2018
Address
Address
1688 W Granada Blvd STE 2A, Ormond Beach, FL 32174
National Provider ID: 1164528915
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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PECKS' FAMILY PRACTICE, PLC

1688 W Granada Blvd SUITE 2A, Ormond Beach, FL 32174

Status:
Inactive
Inactive reason:
CANCEL ADM DISS/REV
Registration:
Aug 16, 2000
Inactive since:
Oct 3, 2005
State ID:
L00000009831
Business type:
Florida Limited Liability Company
Benjamin J Peck, 1688 W Granada Blvd SUITE 2A, Ormond Beach, FL 32174 (Physical)
Agent:
Benjamin Peck,1688 W Granada Blvd SUITE 2A, Ormond Beach, FL 32174 (Physical)
EIN:
59-3667278

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