Healthcare Provider Details

I. General information

NPI: 1407914930
Provider Name (Legal Business Name): PETER BRANDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 BARNES AVE NW
SEATTLE WA
98107-3839
US

IV. Provider business mailing address

5410 BARNES AVE NW
SEATTLE WA
98107-3839
US

V. Phone/Fax

Practice location:
  • Phone: 206-784-0810
  • Fax: 206-784-2250
Mailing address:
  • Phone: 206-784-0810
  • Fax: 206-784-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD00029025
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: