Healthcare Provider Details

I. General information

NPI: 1770668576
Provider Name (Legal Business Name): ROBERT BERNARD DEVNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 11/24/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19515 NORTH CREEK PKWY STE 202
BOTHELL WA
98011-8200
US

IV. Provider business mailing address

19515 NORTH CREEK PKWY STE 202
BOTHELL WA
98011-8200
US

V. Phone/Fax

Practice location:
  • Phone: 425-949-0204
  • Fax: 855-936-3250
Mailing address:
  • Phone: 425-949-0204
  • Fax: 855-936-3250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD00019763
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00019763
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1053933
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 2
Identifier5895
Identifier TypeOTHER
Identifier State
Identifier IssuerINTERNAL ID-MOTOR VEHICLE ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: