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General NPI Number Information
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NPI Number | 1740600840
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Entity Type | Individual
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Provider Name | PETERS T. OTLANS MD
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Gender | Male
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 16259 SYLVESTER RD SW STE 501
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City | BURIEN
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State | WA
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Zip | 98166-3059
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Country | US
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Telephone | 206-243-1100
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Fax | 206-431-0835
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Provider Business Mailing Address
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Address Line | 16259 SYLVESTER RD SW STE 501
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City | BURIEN
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State | WA
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Zip | 98166-3059
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Country | US
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Telephone | 206-243-1100
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Fax | 206-431-0835
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | MD61055362
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD61055362
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License Number State | WA
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