Provider Demographics
NPI:1922190065
Name:PETER E. LOGERFO, MD, PLLC
Entity type:Organization
Organization Name:PETER E. LOGERFO, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LOGERFO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-548-0453
Mailing Address - Street 1:11025 CANYON RD E
Mailing Address - Street 2:SUITE A
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-4268
Mailing Address - Country:US
Mailing Address - Phone:253-548-0453
Mailing Address - Fax:253-548-3049
Practice Address - Street 1:11025 CANYON RD E
Practice Address - Street 2:SUITE A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-4264
Practice Address - Country:US
Practice Address - Phone:253-548-0453
Practice Address - Fax:253-548-3049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7117492Medicaid
WA7117492Medicaid
WAGAB15753Medicare PIN