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 1:1830 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4275
Mailing Address - Country:US
Mailing Address - Phone:970-384-5096
Mailing Address - Fax:970-947-9048
Practice Address - Street 1:1830 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4275
Practice Address - Country:US
Practice Address - Phone:970-384-5096
Practice Address - Fax:970-947-9048
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0038573207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1851397210Medicaid
WA0230136OtherL&I AND CRIME VICTIMS
WA731813OtherAETNA
WA3174DYOtherREGENCE
WAG8872949Medicare PIN
WA3174DYOtherREGENCE