1073511515 NPI number — MR. DAVID JOHN BOBIAK ARNP/CRNA

Table of content: MR. DAVID JOHN BOBIAK ARNP/CRNA (NPI 1073511515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073511515 NPI number — MR. DAVID JOHN BOBIAK ARNP/CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOBIAK
Provider First Name:
DAVID
Provider Middle Name:
JOHN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ARNP/CRNA
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:
1073511515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
990 SYLVAN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREMERTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98310-2851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-479-3657
Provider Business Mailing Address Fax Number:
360-373-7616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
990 SYLVAN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREMERTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98310-2851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-479-3657
Provider Business Practice Location Address Fax Number:
360-373-7616
Provider Enumeration Date:
07/08/2005

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: 367500000X , with the licence number:  AP30005417 , 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: 7215BO . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0159563 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 910847215 . This is a "TRIWEST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 910847215 . This is a "UNIFORM MEDICAL" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 016487001 . This is a "GROUP HEALTH CORP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 430070634 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 910847215 . This is a "PREMERA BLUE CROSS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 910847215-33 . This is a "KPS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9612557 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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