Provider Demographics
NPI:1437227162
Name:BETHEL, ROBERT V (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:V
Last Name:BETHEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20730 BOND RD NE
Mailing Address - Street 2:STE 205
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9000
Mailing Address - Country:US
Mailing Address - Phone:360-779-9727
Mailing Address - Fax:360-779-9224
Practice Address - Street 1:20730 BOND RD NE
Practice Address - Street 2:STE 205
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9000
Practice Address - Country:US
Practice Address - Phone:360-779-9727
Practice Address - Fax:360-779-9224
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1097203Medicaid
WA010063448OtherRAILROAD MEDICARE
WA010063448OtherRAILROAD MEDICARE
WA1097203Medicaid