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General NPI Number Information
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NPI Number | 1023530573
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Entity Type | Organization
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Legal Business Name | VINTAGE DIRECT PRIMARY CARE
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Dates
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Enumeration Date | 07/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 19319 7TH AVE NE STE 114
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City | POULSBO
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State | WA
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Zip | 98370-7442
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Country | US
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Telephone | 360-930-3500
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Fax | 866-480-7382
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Provider Business Mailing Address
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Address Line | 19319 7TH AVE NE STE 114
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City | POULSBO
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State | WA
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Zip | 98370-7442
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Country | US
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Telephone | 360-930-3500
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Fax | 866-480-7382
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER MICHAEL LEHMANN
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Credential | MD
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Telephone | 360-930-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00033623
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License Number State | WA
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