Healthcare Provider Details

I. General information

NPI: 1104430065
Provider Name (Legal Business Name): ROBERT L PEISER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 37TH AVE S
SEATTLE WA
98118-1102
US

IV. Provider business mailing address

3800 37TH AVE S
SEATTLE WA
98118-1102
US

V. Phone/Fax

Practice location:
  • Phone: 479-957-7580
  • Fax:
Mailing address:
  • Phone: 479-957-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: