Provider Demographics
NPI:1578565586
Name:CORBETT, ROBERT KENDALL JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KENDALL
Last Name:CORBETT
Suffix:JR
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 1:9631 N NEVADA ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1193
Mailing Address - Country:US
Mailing Address - Phone:509-466-1271
Mailing Address - Fax:509-466-0969
Practice Address - Street 1:9631 N NEVADA ST
Practice Address - Street 2:SUITE 304
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1193
Practice Address - Country:US
Practice Address - Phone:509-466-1271
Practice Address - Fax:509-466-0969
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8214629Medicaid
WAP00247612OtherRAILROAD MEDICARE
WA0200955OtherLABOR AND INDUSTRIES
WA8856248Medicare ID - Type UnspecifiedMEDICARE
WA8214629Medicaid