Healthcare Provider Details

I. General information

NPI: 1013969856
Provider Name (Legal Business Name): PETER CAMPBELL GREGORY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32014 32ND AVE S
FEDERAL WAY WA
98001-9625
US

IV. Provider business mailing address

32014 32ND AVE S SOUND VASCULAR & VEIN
FEDERAL WAY WA
98001
US

V. Phone/Fax

Practice location:
  • Phone: 253-874-7107
  • Fax: 253-874-1923
Mailing address:
  • Phone: 253-874-7107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD00045907
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: