Healthcare Provider Details

I. General information

NPI: 1063475291
Provider Name (Legal Business Name): ROBERT GEORGE TEARSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 09/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4471 NOB HILL LN
FREELAND WA
98249
US

IV. Provider business mailing address

PO BOX 1228
FREELAND WA
98249-1228
US

V. Phone/Fax

Practice location:
  • Phone: 541-225-7476
  • Fax:
Mailing address:
  • Phone: 541-225-7476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD13116
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number60656697
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: