MEDICARE: DR. PETER N GROTE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD00031272	WA

General Provider Information

NPI Number	:	1194813600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER N GROTE MD

Provider Business Mailing Address
First Line	:	1145 BROADWAY
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-4201
Country	:	US
Telephone Number	:	206-860-5414
Fax Number	:	206-720-8462

Provider Business Practice Location Address
First Line	:	6804 GREENWOOD AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-5228
Country	:	US
Telephone Number	:	207-257-7780
Fax Number	:	206-267-7301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	10/02/2023

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