Provider Demographics
NPI:1093896102
Name:ODLAND, PETER BRIERLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:BRIERLEY
Last Name:ODLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 MADISON ST
Mailing Address - Street 2:SUITE 1480
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3586
Mailing Address - Country:US
Mailing Address - Phone:206-346-6647
Mailing Address - Fax:206-346-6022
Practice Address - Street 1:1229 MADISON ST
Practice Address - Street 2:SUITE 1480
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3586
Practice Address - Country:US
Practice Address - Phone:206-346-6647
Practice Address - Fax:206-346-6022
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026929207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
8722ODOtherBLUE CROSS BLUE SHIELD
OD4638OtherBLUE CROSSBLUE SHIELD
8722ODOtherBLUE CROSS BLUE SHIELD
8722ODOtherBLUE CROSS BLUE SHIELD
911954101OtherEIN