Provider Demographics
NPI:1376639435
Name:ZENTHOEFER, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:ZENTHOEFER
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:P.O. BOX 1049
Mailing Address - Street 2:
Mailing Address - City:MULINO
Mailing Address - State:OR
Mailing Address - Zip Code:97042-1049
Mailing Address - Country:US
Mailing Address - Phone:503-571-3770
Mailing Address - Fax:503-571-2683
Practice Address - Street 1:10100 SE SUNNYSIDE ROAD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9764
Practice Address - Country:US
Practice Address - Phone:503-571-3770
Practice Address - Fax:503-571-2683
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR MD14945207VG0400X
WAWA MD00034771207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology