Provider Demographics
NPI:1508960253
Name:STOKES, ROBERT W (DOPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:STOKES
Suffix:
Gender:M
Credentials:DOPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 BRETON RD SE
Mailing Address - Street 2:SUITE C1
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506
Mailing Address - Country:US
Mailing Address - Phone:616-949-6030
Mailing Address - Fax:616-949-4266
Practice Address - Street 1:1815 BRETON RD SE
Practice Address - Street 2:SUITE C1
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506
Practice Address - Country:US
Practice Address - Phone:616-949-6030
Practice Address - Fax:616-949-4266
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRS007591207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0754102185OtherBCBS
E22684Medicare UPIN
5410218Medicare ID - Type Unspecified