Provider Demographics
NPI:1063454155
Name:HIPP, ROBERT SANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SANDER
Last Name:HIPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 9532
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409
Mailing Address - Country:US
Mailing Address - Phone:360-491-5999
Mailing Address - Fax:360-491-5946
Practice Address - Street 1:3920 CAPITOL MALL DR
Practice Address - Street 2:SUITE 302
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502
Practice Address - Country:US
Practice Address - Phone:360-754-3507
Practice Address - Fax:360-236-1457
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA12773208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA115567OtherLABOR & INDUSTRY
WA8198020Medicaid
WAGAB01482Medicare PIN
A08444Medicare UPIN