Provider Demographics
NPI:1710035118
Name:DALM, ROBERT S (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:DALM
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 1:540 W HENDRICKSON RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3013
Mailing Address - Country:US
Mailing Address - Phone:360-683-5215
Mailing Address - Fax:360-683-5268
Practice Address - Street 1:540 W HENDRICKSON RD
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3013
Practice Address - Country:US
Practice Address - Phone:360-683-5215
Practice Address - Fax:360-683-5268
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004370363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant