Provider Demographics
NPI:1457490187
Name:JONES, ROBERT BRADLEY (LMP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRADLEY
Last Name:JONES
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 FREMONT AVE N
Mailing Address - Street 2:STE. 412
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-2709
Mailing Address - Country:US
Mailing Address - Phone:206-465-6138
Mailing Address - Fax:
Practice Address - Street 1:3601 FREMONT AVE N
Practice Address - Street 2:STE. 412
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-2709
Practice Address - Country:US
Practice Address - Phone:206-465-6138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014779174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist