Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | MD00045907 | WA |
NPI | 1013969856 |
---|---|
Provider Name | Peter Campbell Gregory |
First Address | Federal Way, WA 98001 |
Second Address | Federal Way, WA 98001-9625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 20/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1423GR | BCBS (01) | WA |
8472359 | (05) | WA |