Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | OP00001599 | WA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | OP00001599 | WA |
NPI | 1063453165 |
---|---|
Provider Name | Christian Movall Peterson |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98133-9463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 24/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063453165 | (05) | WA |
G46049 | (02) | WA |