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General NPI Number Information
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NPI Number | 1336193010
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Entity Type | Individual
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Provider Name | PAUL E. PESHECK MD
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 21601 76TH AVE W
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City | EDMONDS
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State | WA
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Zip | 98026-7507
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Country | US
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Telephone | 425-640-4000
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Fax | 206-672-0211
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Provider Business Mailing Address
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Address Line | PO BOX 34960
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City | SEATTLE
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State | WA
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Zip | 98124-1960
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Country | US
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Telephone | 503-372-2740
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Fax | 503-372-2754
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD00016724
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License Number State | WA
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