Basic Information
| Provider Information | |||||||||
| NPI: | 1376519249 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERREID | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3405 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992203405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098922700 | ||||||||
| FaxNumber: | 5098922740 | ||||||||
| Practice Location | |||||||||
| Address1: | 1280 116TH AVE NE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980043803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256460922 | ||||||||
| FaxNumber: | 4256460925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 05/19/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | MD00032449 | WA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 8174252 | 05 | WA | MEDICAID |