Basic Information
| Provider Information | |||||||||
| NPI: | 1730158148 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANDT | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 MADISON ST. | ||||||||
| Address2: | SUITE 901 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981041172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062648100 | ||||||||
| FaxNumber: | 2062648689 | ||||||||
| Practice Location | |||||||||
| Address1: | 1231 116TH AVE NE | ||||||||
| Address2: | SUITE 750 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980043804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254553600 | ||||||||
| FaxNumber: | 4254553920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 05/15/2012 | ||||||||
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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 | 207X00000X | MD00023819 | WA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0182419 | 01 | WA | L & I | OTHER | G8899975 | 01 | WA | MEDICARE EMRI | OTHER | P00284046 | 01 | WA | MEDICARE RR KING CO. | OTHER | G8861216 | 01 | WA | MEDICARE POSM | OTHER |