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General NPI Number Information
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NPI Number | 1831194737
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Entity Type | Individual
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Provider Name | PETER FREDERICK BANITT M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 19260 SW 65TH AVE STE 420
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City | TUALATIN
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State | OR
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Zip | 97062-5712
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Country | US
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Telephone | 503-692-0405
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Fax | 503-274-5400
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Provider Business Mailing Address
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Address Line | 541 NE 20TH AVE STE 225
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City | PORTLAND
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State | OR
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Zip | 97232-2895
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Country | US
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Telephone | 503-963-2801
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Fax | 503-963-2825
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD21525
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | MD21525
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License Number State | OR
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