Provider Demographics
NPI:1083652689
Name:PECKOO, ROSALEE JENIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSALEE
Middle Name:JENIFER
Last Name:PECKOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSALEE
Other - Middle Name:JENIFER
Other - Last Name:PECKOO-WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATTAHOOCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:32324-1107
Mailing Address - Country:US
Mailing Address - Phone:850-663-7496
Mailing Address - Fax:
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATTAHOOCHEE
Practice Address - State:FL
Practice Address - Zip Code:32324-1107
Practice Address - Country:US
Practice Address - Phone:850-663-7496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine