1013004662 NPI number — DR. ROBERT EDWARD SANDS MD

Table of content: DR. ROBERT EDWARD SANDS MD (NPI 1013004662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013004662 NPI number — DR. ROBERT EDWARD SANDS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDS
Provider First Name:
ROBERT
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1013004662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3609 SO 19TH ST
Provider Second Line Business Mailing Address:
ROBERT E SANDS MD
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-752-6056
Provider Business Mailing Address Fax Number:
253-759-7129

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3609 SO 19TH ST
Provider Second Line Business Practice Location Address:
ROBERT E SANDS MD
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-752-6056
Provider Business Practice Location Address Fax Number:
253-759-7129
Provider Enumeration Date:
10/06/2006

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: 2084P0800X , with the licence number:  25200M00015092 , 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: 200227 . This is a "STATE PROVIDER #" identifier . This identifiers is of the category "OTHER".
  • Identifier: T64237 . This is a "TIN" identifier . This identifiers is of the category "OTHER".