Healthcare Provider Details

I. General information

NPI: 1659514909
Provider Name (Legal Business Name): HENRY FRANCIS PELTO III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 5TH AVE NE STE 201 WEST
SEATTLE WA
98125-7025
US

IV. Provider business mailing address

10601 5TH AVE NE STE 201 WEST
SEATTLE WA
98125-7025
US

V. Phone/Fax

Practice location:
  • Phone: 206-287-6400
  • Fax: 206-341-1801
Mailing address:
  • Phone: 206-287-6400
  • Fax: 206-341-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD60298925
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberML60096913
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: