Healthcare Provider Details

I. General information

NPI: 1699070052
Provider Name (Legal Business Name): CARRIE M PEECHER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 SOUTH 65 HIGHWAY BUILDING A
MARSHALL MO
65340-3702
US

IV. Provider business mailing address

2305 SOUTH 65 HIGHWAY
MARSHALL MO
65340-3702
US

V. Phone/Fax

Practice location:
  • Phone: 660-886-7800
  • Fax: 660-831-3328
Mailing address:
  • Phone: 660-886-7431
  • Fax: 660-886-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2010019790
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: