Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 143046 | AK |
N | 111NI0900X | Internist | 143046 | AK |
N | 207R00000X | Internist | MD60827333 | WA |
N | 111NI0900X | Internist | MD60827333 | WA |
N | 207RH0000X | Hematologist | 143046 | AK |
N | 207RH0000X | Hematologist | MD60827333 | WA |
N | 207RH0003X | Hematology & Oncology | G57545 | CA |
N | 207RX0202X | Medical Oncology | 143046 | AK |
Y | 207RX0202X | Medical Oncology | MD60827333 | WA |
NPI | 1407891641 |
---|---|
Provider Name | Peter T Reissmann |
First Address | Vancouver, WA 98683-8004 |
Second Address | Bellingham, WA 98225-1919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 02/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G575450 | (05) | CA |
E24287 | (02) | CA |