Provider Demographics
NPI:1457424285
Name:PEIXOTTO, JOHN HARVEY (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HARVEY
Last Name:PEIXOTTO
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:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1911
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-383-3553
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000266942085R0202X
WAMD000266942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8951846OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
WAG8878582OtherPTAN-CMBC
WA8125353Medicaid
WA8945537OtherLABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI
WAG8882928OtherPTAN-MIO1
WAG8927546OtherPTAN-UAOM
WA0243531OtherLABOR AND INDUSTRIES-CAROL MILGARD BREAST CENTER
WA8945828OtherLABOR AND INDUSTRIES CRIME VICTIMS-TRA
WA8949630OtherLABOR AND INDUSTRIES CRIME VICTIMS-CAROL MILGARD BREAST CENTER
WA0249537OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WA0260002OtherLABOR AND INDUSTRIES-UNION AVENUE OPEN MRI
WAP00689878OtherRR MEDICARE-CAROL MILGARD BREAST CENTER
WA8945828OtherLABOR AND INDUSTRIES CRIME VICTIMS-TRA
WAP00689878OtherRR MEDICARE-CAROL MILGARD BREAST CENTER