Provider Demographics
NPI:1518910991
Name:BAMMERT, ROBERT E (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:BAMMERT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 SHERIDAN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2901
Mailing Address - Country:US
Mailing Address - Phone:360-385-3500
Mailing Address - Fax:360-385-5496
Practice Address - Street 1:1010 SHERIDAN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2901
Practice Address - Country:US
Practice Address - Phone:360-385-3500
Practice Address - Fax:360-385-5496
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB27057Medicare ID - Type Unspecified
WAS44412Medicare UPIN