Individual
DR. GERALDINE ANNE PETERDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
112 S GREENRIDGE DR, LIBERTY LAKE, WA 99019-9566
(509) 255-1000
Mailing address
PO BOX 727, ALLIED PATHOLOGY, PC, LIBERTY LAKE, WA 99019-0727
(509) 255-1000
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
MD00041937
WA
207ZP0101X
Anatomic Pathology Physician
Primary
MD00041937
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8331084
—
WA
01
—
AB 35581
MEDICARE WA
WA
Enumeration date
06/03/2006
Last updated
11/17/2014
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