Basic Information
| Provider Information | |||||||||
| NPI: | 1457424285 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEIXOTTO | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | HARVEY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1535 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984011535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537614200 | ||||||||
| FaxNumber: | 2533833553 | ||||||||
| Practice Location | |||||||||
| Address1: | 1304 FAWCETT AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984021911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537614200 | ||||||||
| FaxNumber: | 2533833553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 09/16/2016 | ||||||||
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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 | 2085R0202X | 00026694 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD00026694 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 8951846 | 01 | WA | LABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST | OTHER | G8878582 | 01 | WA | PTAN-CMBC | OTHER | 8125353 | 05 | WA | MEDICAID | 8945537 | 01 | WA | LABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI | OTHER | G8882928 | 01 | WA | PTAN-MIO1 | OTHER | G8927546 | 01 | WA | PTAN-UAOM | OTHER | 0243531 | 01 | WA | LABOR AND INDUSTRIES-CAROL MILGARD BREAST CENTER | OTHER | 8945828 | 01 | WA | LABOR AND INDUSTRIES CRIME VICTIMS-TRA | OTHER | 8949630 | 01 | WA | LABOR AND INDUSTRIES CRIME VICTIMS-CAROL MILGARD BREAST CENTER | OTHER | 0249537 | 01 | WA | LABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST | OTHER | 0260002 | 01 | WA | LABOR AND INDUSTRIES-UNION AVENUE OPEN MRI | OTHER | P00689878 | 01 | WA | RR MEDICARE-CAROL MILGARD BREAST CENTER | OTHER |