Provider Demographics
NPI:1992815716
Name:CARRICABURU, PIERRE G (MD)
Entity type:Individual
Prefix:DR
First Name:PIERRE
Middle Name:G
Last Name:CARRICABURU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2300 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-2257
Mailing Address - Country:US
Mailing Address - Phone:307-857-1211
Mailing Address - Fax:307-857-1439
Practice Address - Street 1:2300 ROSE LN
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2257
Practice Address - Country:US
Practice Address - Phone:307-857-1211
Practice Address - Fax:307-857-1439
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2927-A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine