Provider Demographics
NPI:1649356189
Name:KOTHENBEUTEL, ROBERT LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEWIS
Last Name:KOTHENBEUTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:263 RAINIER AVE S # 200
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2055
Mailing Address - Country:US
Mailing Address - Phone:425-255-0471
Mailing Address - Fax:425-255-0262
Practice Address - Street 1:263 RAINIER AVE S
Practice Address - Street 2:#200
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2055
Practice Address - Country:US
Practice Address - Phone:425-255-0471
Practice Address - Fax:425-255-0262
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00012137207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8107104Medicaid
WA8107104Medicaid