Provider Demographics
NPI:1275809329
Name:RUBENSTEIN, PETER BRYAN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:BRYAN
Last Name:RUBENSTEIN
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 1:909 SQUALICUM WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2077
Mailing Address - Country:US
Mailing Address - Phone:360-647-3377
Mailing Address - Fax:360-752-3214
Practice Address - Street 1:909 SQUALICUM WAY STE 102
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2077
Practice Address - Country:US
Practice Address - Phone:360-647-3377
Practice Address - Fax:360-752-3214
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60770459207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2018436Medicaid