=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962630053
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER J. KARLIN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2009
-----------------------------------------------------
Last Update Date | 09/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 WASHINGTON AVE NO
-----------------------------------------------------
City | EATONVILLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-832-7300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 WASHINGTON AVE NO
-----------------------------------------------------
City | EATONVILLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-832-7300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD60293910
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------