Provider Demographics
NPI:1346263894
Name:SARGENT, ROBERT T JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:SARGENT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:22000 MARINE VIEW DR S STE 100
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6233
Mailing Address - Country:US
Mailing Address - Phone:206-870-4460
Mailing Address - Fax:206-870-4770
Practice Address - Street 1:22000 MARINE VIEW DR S STE 100
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6233
Practice Address - Country:US
Practice Address - Phone:206-870-4460
Practice Address - Fax:206-870-4770
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA310626OtherSTATE L&I
WAG8925193Medicare PIN