Healthcare Provider Details

I. General information

NPI: 1982129219
Provider Name (Legal Business Name): ROBERT HERMANN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 108TH ST SW
LAKEWOOD WA
98499-3724
US

IV. Provider business mailing address

PO BOX 98886
LAKEWOOD WA
98496-8886
US

V. Phone/Fax

Practice location:
  • Phone: 253-589-6573
  • Fax: 253-984-1079
Mailing address:
  • Phone: 253-584-3577
  • Fax: 253-584-8916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HERMANN
Title or Position: DOCTOR
Credential: MD
Phone: 509-999-1790