1619056520 NPI number — DR. ALDEN WARREN ROBERTS MD

Table of content: PAULA SHRYNE (NPI 1427180249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619056520 NPI number — DR. ALDEN WARREN ROBERTS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
ALDEN
Provider Middle Name:
WARREN
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:
1619056520
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18615 NE 174TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRUSH PRAIRIE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98606-8733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-892-6189
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 SE PARK PLAZA DR
Provider Second Line Business Practice Location Address:
STE 140
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98684-5886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-449-7031
Provider Business Practice Location Address Fax Number:
360-449-7053
Provider Enumeration Date:
11/02/2006

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: 208600000X , with the licence number:  WA MD00027001 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: OR MD16429 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com