Provider Demographics
NPI:1073506804
Name:ROE, ELAINE BOLLING (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:BOLLING
Last Name:ROE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E MEEKER ST
Mailing Address - Street 2:STE 300
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-5904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:403 E MEEKER ST
Practice Address - Street 2:STE 200
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-5904
Practice Address - Country:US
Practice Address - Phone:253-852-2866
Practice Address - Fax:253-852-3102
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041977207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine