Provider Demographics
NPI:1265049829
Name:ROBERT I HUSTRULID MD PLLC
Entity type:Organization
Organization Name:ROBERT I HUSTRULID MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:IVER
Authorized Official - Last Name:HUSTRULID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-951-3979
Mailing Address - Street 1:3807 S SOMMER RD
Mailing Address - Street 2:
Mailing Address - City:VERADALE
Mailing Address - State:WA
Mailing Address - Zip Code:99037-9136
Mailing Address - Country:US
Mailing Address - Phone:509-951-3979
Mailing Address - Fax:
Practice Address - Street 1:1201 N EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-5094
Practice Address - Country:US
Practice Address - Phone:509-951-3979
Practice Address - Fax:509-495-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty