Provider Demographics
NPI:1356650949
Name:ARNOLD L PETERSEN II MD PC
Entity Type:Organization
Organization Name:ARNOLD L PETERSEN II MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:L
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:503-256-0890
Mailing Address - Street 1:PO BOX 84627
Mailing Address - Street 2:LOCKBOX 310115
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5927
Mailing Address - Country:US
Mailing Address - Phone:503-256-0890
Mailing Address - Fax:503-255-2150
Practice Address - Street 1:10101 SE MAIN ST
Practice Address - Street 2:SUITE 2011
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2455
Practice Address - Country:US
Practice Address - Phone:503-256-0890
Practice Address - Fax:503-255-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD07945207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR100612Medicare UPIN