Provider Demographics
NPI:1629081435
Name:MARSH, PETER BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:BRADLEY
Last Name:MARSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 SE STEVENS COURT
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97086
Mailing Address - Country:US
Mailing Address - Phone:503-813-2000
Mailing Address - Fax:503-353-7337
Practice Address - Street 1:12100 SE STEVENS COURT
Practice Address - Street 2:SUITE 106
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97086
Practice Address - Country:US
Practice Address - Phone:503-331-6330
Practice Address - Fax:503-353-7337
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2015-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20893207W00000X
WAMD00036997207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology