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General NPI Number Information
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NPI Number | 1588899488
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Entity Type | Individual
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Provider Name | CAROLEE MARIE CUTLER PECK M.D., M.P.H.
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Gender | Female
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 3365 CHASEWOOD DRIVE
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City | AMMON
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State | ID
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Zip | 83406
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Country | US
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Telephone | 208-228-5555
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Fax | 208-228-0077
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Provider Business Mailing Address
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Address Line | PO BOX 50678
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City | IDAHO FALLS
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State | ID
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Zip | 83405-0678
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Country | US
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Telephone | 208-228-5555
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Fax | 208-228-0077
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | M-15305
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License Number State | ID
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