Organization
COMMUNITY CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN PETERSON (CEO)
(208) 525-8448
Entity
Organization
Contact information
Practice address
72 E MAIN ST, REXBURG, ID 83440-1926
(208) 359-1770
(208) 359-1780
Mailing address
72 E MAIN ST, REXBURG, ID 83440-1926
(208) 359-1770
(208) 359-1780
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
07/26/2006
Last updated
08/22/2020
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