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NPI Code Detail

MEDICARE: DR. PETER M THOMAS PHD

MEDICARE:  DR. PETER M THOMAS  PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist1172WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113567OTHERNO OTHER IDENTIFIERS

General Provider Information

NPI Number : 1376656363
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETER M THOMAS PHD
Provider Business Mailing Address
First Line : 19018 CORLISS AVE N
Second Line :
City : SHORELINE
State : WA
Zip : 98133-4146
Country : US
Telephone Number : 206-356-8724
Fax Number : 206-417-2841
Provider Business Practice Location Address
First Line : 4649 SUNNYSIDE AVE N
Second Line : SUITE 300
City : SEATTLE
State : WA
Zip : 98103-6900
Country : US
Telephone Number : 206-634-2162
Fax Number : 206-417-2841
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2006
Last Update Date : 05/11/2022

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