Provider Demographics
NPI:1558389544
Name:NOONEY, ROBERT R (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:NOONEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:404 YAUGER WAY SW
Mailing Address - Street 2:SUITE 150
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8660
Mailing Address - Country:US
Mailing Address - Phone:360-754-2300
Mailing Address - Fax:360-754-1044
Practice Address - Street 1:404 YAUGER WAY SW
Practice Address - Street 2:SUITE 150
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8660
Practice Address - Country:US
Practice Address - Phone:360-754-2300
Practice Address - Fax:360-754-1044
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOPO00001277207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA262210405OtherTAX ID
WA7492OtherQUALMED
WA48546OtherL&I WORKERS COMP
WANO1029OtherBLUE CROSS BLUE SHIELD
WA1083021Medicaid
WA424713001OtherGROUP HEALTH
WA1083021Medicaid
WA48546OtherL&I WORKERS COMP
WA424713001OtherGROUP HEALTH