Basic Information
| Provider Information | |||||||||
| NPI: | 1497792261 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOLLROS | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | M/S B5552 PO BOX 5371 | ||||||||
| Address2: | SEATTLE CHILDREN'S HOSPTIAL | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981455552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069872078 | ||||||||
| FaxNumber: | 2069872649 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 SAND POINT WAY NE | ||||||||
| Address2: | SEATTLE CHILDREN'S HOSPTIAL M/S B5552 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981055552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069872078 | ||||||||
| FaxNumber: | 2069872649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 03/26/2012 | ||||||||
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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 | 2084N0402X | MD 60111285 | WA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
ID Information
| ID | Type | State | Issuer | Description | MD 60111285 | 01 | WA | STATE LICENSE | OTHER |