Individual
PETER STACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
4770 SW WATSON AVE, BEAVERTON, OR 97005-0511
(503) 805-4720
(971) 223-0969
Mailing address
4770 SW WATSON AVE, BEAVERTON, OR 97005-0511
(503) 805-4720
(971) 223-0969
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
DP198085
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500798722
—
OR
Enumeration date
07/18/2017
Last updated
06/27/2022
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