Organization
COMMUNITY CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN PETERSON (DEO)
(208) 525-8448
Entity
Organization
Contact information
Practice address
1995 E 17TH ST, IDAHO FALLS, ID 83404-6493
(208) 529-5252
(208) 529-4434
Mailing address
1995 E 17TH ST, IDAHO FALLS, ID 83404-6493
(208) 529-5252
(208) 529-4434
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
08/09/2006
Last updated
08/22/2020
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