Provider Demographics
NPI:1568026433
Name:PACUT, PETER PAUL (MD)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:PAUL
Last Name:PACUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 BIRCHWOOD AVE SUITES 201 AND 202
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:360-788-6870
Mailing Address - Fax:360-788-6872
Practice Address - Street 1:710 BIRCHWOOD AVE STE 201
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1720
Practice Address - Country:US
Practice Address - Phone:360-788-6870
Practice Address - Fax:360-788-6872
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2024-06-20
Deactivation Date:2020-01-13
Deactivation Code:
Reactivation Date:2020-01-17
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD614838662084N0400X, 2084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine