Provider Demographics
NPI:1982683322
Name:VINCENT, PETER MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MICHAEL
Last Name:VINCENT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12911 120TH AVE NE STE C50
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3080
Mailing Address - Country:US
Mailing Address - Phone:425-899-3234
Mailing Address - Fax:425-899-3235
Practice Address - Street 1:12911 120TH AVE NE STE C50
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3080
Practice Address - Country:US
Practice Address - Phone:425-899-3234
Practice Address - Fax:425-899-3235
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO000000750213ES0131X
WAPO00000750213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB39803Medicare ID - Type Unspecified
U97135Medicare UPIN