Provider Demographics
NPI:1013118652
Name:ROBERT H PRICE MD, PLLC
Entity type:Organization
Organization Name:ROBERT H PRICE MD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-379-7191
Mailing Address - Street 1:10315 19TH AVE SE
Mailing Address - Street 2:STE 112
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4268
Mailing Address - Country:US
Mailing Address - Phone:425-379-7191
Mailing Address - Fax:425-379-8271
Practice Address - Street 1:10315 19TH AVE SE
Practice Address - Street 2:STE 112
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4268
Practice Address - Country:US
Practice Address - Phone:425-379-7191
Practice Address - Fax:425-379-8271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025709261QS1200X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAX70039Medicare UPIN
WAGAB27337Medicare UPIN