Healthcare Provider Details

I. General information

NPI: 1649636887
Provider Name (Legal Business Name): MOBILE SLEEP ANESTHESIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3119 MAPLE RIDGE CT
BELLINGHAM WA
98229-2391
US

IV. Provider business mailing address

3119 MAPLE RIDGE CT
BELLINGHAM WA
98229-2391
US

V. Phone/Fax

Practice location:
  • Phone: 360-922-2100
  • Fax:
Mailing address:
  • Phone: 360-922-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00044482
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberMD00044482
License Number StateWA

VIII. Authorized Official

Name: DR. PETER R PFEIFFER
Title or Position: OWNER
Credential: MD
Phone: 360-922-2100