Basic Information
| Provider Information | |||||||||
| NPI: | 1861584641 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENNING | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | MARSHALL | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9040 JACKSON AVE | ||||||||
| Address2: | MADIGAN ARMY MEDICAL CENTER, RHEUMATOLOGY CLINIC | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984311100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539682287 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9040 JACKSON AVE | ||||||||
| Address2: | MADIGAN ARMY MEDICAL CENTER, RHEUMATOLOGY CLINIC | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984311100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539682287 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 08/05/2013 | ||||||||
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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 | 207R00000X | 376 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RR0500X | 376 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.