Healthcare Provider Details

I. General information

NPI: 1003978644
Provider Name (Legal Business Name): ROBERT D. KUGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 LILLY RD NE STE D
OLYMPIA WA
98506-5069
US

IV. Provider business mailing address

143 WOODCREST DR
CHEHALIS WA
98532-8956
US

V. Phone/Fax

Practice location:
  • Phone: 360-491-8667
  • Fax:
Mailing address:
  • Phone: 360-491-8667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25126
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: