Provider Demographics
NPI:1467590075
Name:SUNDERLAND, PETER MARTIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MARTIN
Last Name:SUNDERLAND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6566 NE ROSEBAY DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5023
Mailing Address - Country:US
Mailing Address - Phone:503-717-2572
Mailing Address - Fax:
Practice Address - Street 1:6566 NE ROSEBAY DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5023
Practice Address - Country:US
Practice Address - Phone:503-717-2572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR097006794N3363LC0200X
WAAP30003495363LC0200X, 367500000X
CA537692 9479363LC0200X
OR097006794CRNA367500000X
CA537692 2351367500000X
CANA2351367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGW209ZMedicare PIN