Healthcare Provider Details

I. General information

NPI: 1972823094
Provider Name (Legal Business Name): PETER SCOTT DAMMEN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 43RD ST
RENTON WA
98055-5714
US

IV. Provider business mailing address

400 S 43RD ST
RENTON WA
98055-5714
US

V. Phone/Fax

Practice location:
  • Phone: 425-228-3440
  • Fax: 425-656-5016
Mailing address:
  • Phone: 425-228-3440
  • Fax: 425-656-5016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-02344
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60582305
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: