MEDICARE: DR. ROBERTA HAYNES DE REGT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	025209	WA

General Provider Information

NPI Number	:	1134167620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTA HAYNES DE REGT M.D.

Provider Business Mailing Address
First Line	:	10930 250TH AVE NE
Second Line	:
City	:	REDMOND
State	:	WA
Zip	:	98053-6236
Country	:	US
Telephone Number	:	206-618-2602
Fax Number	:

Provider Business Practice Location Address
First Line	:	10930 250TH AVE NE
Second Line	:
City	:	REDMOND
State	:	WA
Zip	:	98053-6236
Country	:	US
Telephone Number	:	206-618-2602
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	09/20/2024

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