Healthcare Provider Details

I. General information

NPI: 1902878580
Provider Name (Legal Business Name): JOHN PETER NEY M.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040A FITZSIMMONS DR.
TACOMA WA
98413
US

IV. Provider business mailing address

445 26TH AVE E
SEATTLE WA
98112-4728
US

V. Phone/Fax

Practice location:
  • Phone: 206-968-0496
  • Fax: 253-968-0443
Mailing address:
  • Phone: 206-568-5490
  • Fax: 253-968-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberIN 01056299A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: