Provider Demographics
NPI:1730279696
Name:ROBERTSON, H THOMAS II
Entity Type:Individual
Prefix:
First Name:H
Middle Name:THOMAS
Last Name:ROBERTSON
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HOWARD
Other - Middle Name:THOMAS
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF WASHINGTON MEDICAL CTR
Practice Address - Street 2:1959 NE PACIFIC ST
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6166
Practice Address - Country:US
Practice Address - Phone:206-598-4615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00011303207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
9664OtherINTERNAL ID-MOTOR VEHICLE ID
WA0232074OtherL&I
WA1730279696Medicaid
WA1730279696Medicaid
9664OtherINTERNAL ID-MOTOR VEHICLE ID