Provider Demographics
NPI:1407914930
Name:BRANDON, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:BRANDON
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 1:5410 BARNES AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3839
Mailing Address - Country:US
Mailing Address - Phone:206-784-0810
Mailing Address - Fax:206-784-2250
Practice Address - Street 1:5410 BARNES AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3839
Practice Address - Country:US
Practice Address - Phone:206-784-0810
Practice Address - Fax:206-784-2250
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029025207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00029025OtherSTATE LICENSE
WAMD00029025OtherSTATE LICENSE