Provider Demographics
NPI:1861251670
Name:MEAD, PETER D (CRM)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:D
Last Name:MEAD
Suffix:
Gender:M
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 NW 8TH AVE APT 419
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3702
Mailing Address - Country:US
Mailing Address - Phone:971-888-1101
Mailing Address - Fax:
Practice Address - Street 1:8 NW 8TH AVE APT 419
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3702
Practice Address - Country:US
Practice Address - Phone:971-888-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-CRM-2964175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist