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NPI Code Detail

MEDICARE: JEFFREY L PECKINPAUGH MD

MEDICARE: JEFFREY L PECKINPAUGH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207WX0200XOphthalmic Plastic and Reconstructive Surgery PhysicianMED-PHYS-LIC-18600MT
2207W00000XOphthalmology Physician18600MT

General Provider Information

NPI Number : 1083817647
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY L PECKINPAUGH MD
Provider Business Mailing Address
First Line : PO BOX 4194
Second Line :
City : BUTTE
State : MT
Zip : 59702-4194
Country : US
Telephone Number : 206-910-2452
Fax Number : 855-802-4392
Provider Business Practice Location Address
First Line : 1905 W COLLEGE ST
Second Line :
City : BOZEMAN
State : MT
Zip : 59718-4061
Country : US
Telephone Number : 406-490-9953
Fax Number : 855-802-4392
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2007
Last Update Date : 09/17/2020

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