1831333749 NPI number — KERRI L ROBBINS MD

Table of content: KERRI L ROBBINS MD (NPI 1831333749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831333749 NPI number — KERRI L ROBBINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBBINS
Provider First Name:
KERRI
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831333749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4700 POINT FOSDICK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIG HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98335-1706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-851-7733
Provider Business Mailing Address Fax Number:
253-514-6320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 POINT FOSDICK DR NW STE 219
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIG HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98335-1706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-851-7733
Provider Business Practice Location Address Fax Number:
253-851-8063
Provider Enumeration Date:
04/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ND0101X , with the licence number:  MD60726957 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G8965018 . This is a "MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: GAB32861 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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