Provider Demographics
NPI:1588899488
Name:CUTLER PECK, CAROLEE MARIE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:CAROLEE
Middle Name:MARIE
Last Name:CUTLER PECK
Suffix:
Gender:F
Credentials:MD, MPH
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Mailing Address - Street 1:PO BOX 50678
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83405-0678
Mailing Address - Country:US
Mailing Address - Phone:208-228-5555
Mailing Address - Fax:208-228-0077
Practice Address - Street 1:3365 CHASEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406
Practice Address - Country:US
Practice Address - Phone:208-228-5555
Practice Address - Fax:208-228-0077
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-15305207WX0200X, 207WX0200X
TNMD-48570207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology