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NPI Code Detail

MEDICARE: DR. PETER FREDERICK BANITT M.D.

MEDICARE: DR. PETER FREDERICK BANITT M.D.
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
1207RC0000XCardiovascular Disease PhysicianMD21525OR
2207RI0011XInterventional Cardiology PhysicianMD21525OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831194737
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETER FREDERICK BANITT M.D.
Provider Business Mailing Address
First Line : 541 NE 20TH AVE STE 225
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2895
Country : US
Telephone Number : 503-963-2801
Fax Number : 503-963-2825
Provider Business Practice Location Address
First Line : 19260 SW 65TH AVE STE 420
Second Line :
City : TUALATIN
State : OR
Zip : 97062-5712
Country : US
Telephone Number : 503-692-0405
Fax Number : 503-274-5400
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 11/11/2024

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Directions to “ DR. PETER FREDERICK BANITT M.D.” Practice Location

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