Provider Demographics
NPI:1023361367
Name:ROBERT R. WITHAM, MD. INC,PS
Entity Type:Organization
Organization Name:ROBERT R. WITHAM, MD. INC,PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-452-5322
Mailing Address - Street 1:224 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3908
Mailing Address - Country:US
Mailing Address - Phone:360-452-5322
Mailing Address - Fax:360-452-5236
Practice Address - Street 1:224 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3908
Practice Address - Country:US
Practice Address - Phone:360-452-5322
Practice Address - Fax:360-452-5236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty