Healthcare Provider Details

I. General information

NPI: 1194813600
Provider Name (Legal Business Name): PETER N GROTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6804 GREENWOOD AVE N
SEATTLE WA
98103-5228
US

IV. Provider business mailing address

1145 BROADWAY
SEATTLE WA
98122-4201
US

V. Phone/Fax

Practice location:
  • Phone: 207-257-7780
  • Fax: 206-267-7301
Mailing address:
  • Phone: 206-860-5414
  • Fax: 206-720-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00031272
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: