Individual
PETER LIGHTBODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
26004 104TH AVE SE, KENT, WA 98030-7677
(425) 251-4040
Mailing address
26004 104TH AVE SE, KENT, WA 98030-7677
(425) 251-4040
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD00039118
WA
207Q00000X
Family Medicine Physician
Primary
MD00039118
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8272437
—
WA
Enumeration date
01/22/2007
Last updated
04/27/2021
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