Provider Demographics
NPI:1386631232
Name:GOERTZ, PETER L (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:GOERTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:L
Other - Last Name:ROMERO-GOERTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5157
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98668-5157
Mailing Address - Country:US
Mailing Address - Phone:360-667-3056
Mailing Address - Fax:360-666-0466
Practice Address - Street 1:400 NE MOTHER JOSEPH PL
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3200
Practice Address - Country:US
Practice Address - Phone:360-667-3056
Practice Address - Fax:360-666-0466
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
WAMD00021590207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA08079Medicare UPIN