Provider Demographics
NPI:1780622985
Name:CALF ROBE, DOUGLAS W (PA-C)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:W
Last Name:CALF ROBE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 FAUNTLEROY WAY SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4647
Mailing Address - Country:US
Mailing Address - Phone:206-201-0551
Mailing Address - Fax:206-201-0551
Practice Address - Street 1:4755 FAUNTLEROY WAY SW STE 110
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4669
Practice Address - Country:US
Practice Address - Phone:206-201-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA-10004986363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2155795Medicaid