Provider Demographics
NPI:1013973254
Name:WIRTHLIN, ROBERT SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SAMUEL
Last Name:WIRTHLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 S BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2509
Mailing Address - Country:US
Mailing Address - Phone:509-456-0107
Mailing Address - Fax:509-747-2635
Practice Address - Street 1:427 S BERNARD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2509
Practice Address - Country:US
Practice Address - Phone:509-456-0107
Practice Address - Fax:509-747-2635
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046133207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1831165331OtherSPOKANE EYE SURGERY CENTER
WA0207068OtherLABOR AND INDUSTRIES
WA910852217OtherPREMERA BLUE CROSS
WA1730187899OtherSPOKANE EYE CLINIC, PS
WA1831165331OtherSPOKANE EYE SURGERY CENTER