1740348028 NPI number — MR. ROBERT EDWIN GRAMS JR. ATC

Table of content: MR. ROBERT EDWIN GRAMS JR. ATC (NPI 1740348028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740348028 NPI number — MR. ROBERT EDWIN GRAMS JR. ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAMS
Provider First Name:
ROBERT
Provider Middle Name:
EDWIN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
ATC
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:
1740348028
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:
18015 51ST AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATAC
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98188-8616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-242-1903
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3307 3RD AVE W
Provider Second Line Business Practice Location Address:
STE 301
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98119-1940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-281-2768
Provider Business Practice Location Address Fax Number:
206-281-2266
Provider Enumeration Date:
12/05/2006

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: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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