Provider Demographics
NPI:1851397210
Name:DY, ROBERT M (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:DY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 S 13TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4107
Practice Address - Country:US
Practice Address - Phone:360-814-6113
Practice Address - Fax:360-814-6111
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001859207RG0100X
CODR.0038573207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1851397210Medicaid
WA0230136OtherL&I AND CRIME VICTIMS
WA731813OtherAETNA
WA3174DYOtherREGENCE
WAG8872949Medicare PIN
WA3174DYOtherREGENCE