Provider Demographics
NPI:1750354627
Name:WOODBURY, ROBERT C (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:WOODBURY
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 1:17191 BOTHELL WAY NE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5534
Mailing Address - Country:US
Mailing Address - Phone:206-364-8272
Mailing Address - Fax:206-364-5418
Practice Address - Street 1:17191 BOTHELL WAY NE
Practice Address - Street 2:SUITE 205
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155-5534
Practice Address - Country:US
Practice Address - Phone:206-364-8272
Practice Address - Fax:206-364-5418
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001880204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00283394OtherRAILROAD MEDICARE
WA8450397Medicaid
WAGAB25977Medicare PIN
WAP00283394OtherRAILROAD MEDICARE