Provider Demographics
NPI:1447206958
Name:HERR, ROBERT DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:HERR
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 1:101 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-3413
Mailing Address - Country:US
Mailing Address - Phone:360-678-7656
Mailing Address - Fax:
Practice Address - Street 1:77 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-9556
Practice Address - Country:US
Practice Address - Phone:360-682-2814
Practice Address - Fax:360-678-7614
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038230207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1010507Medicaid
WA8267577Medicaid
WAGAB18952Medicare PIN
E03485Medicare UPIN
WAG8859111Medicare PIN
WAG8859112Medicare PIN
WAG8859113Medicare PIN