Healthcare Provider Details

I. General information

NPI: 1346145323
Provider Name (Legal Business Name): PETER THOMAS FAWCETT R.T.(R)(CT)ARRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 16TH AVE E
SEATTLE WA
98112-5211
US

IV. Provider business mailing address

725 MILL AVE #2
SNOHOMISH WA
98290-2675
US

V. Phone/Fax

Practice location:
  • Phone: 206-326-3712
  • Fax:
Mailing address:
  • Phone: 206-326-3712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License NumberRT60583448
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: