Provider Demographics
NPI:1740383744
Name:ETTLINGER, ROBERT EMIL (MD FACP FACR)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EMIL
Last Name:ETTLINGER
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Gender:M
Credentials:MD FACP FACR
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1901 SOUTH CEDAR STREET
Mailing Address - Street 2:CEDAR MEDICAL CENTER #201
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-272-2261
Mailing Address - Fax:253-627-9842
Practice Address - Street 1:1901 SOUTH CEDAR STREET
Practice Address - Street 2:201 CEDAR MEDICAL CENTER
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-272-2261
Practice Address - Fax:253-627-9842
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2021-05-06
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Provider Licenses
StateLicense IDTaxonomies
WA16479207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1359603Medicaid
A08393Medicare UPIN
WA1359603Medicaid