Healthcare Provider Details

I. General information

NPI: 1679598510
Provider Name (Legal Business Name): GHISLAINE ROBERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GHISLAINE ROBERT MD

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 164TH AVE NE 205
REDMOND WA
98052-3606
US

IV. Provider business mailing address

8630 164TH AVE NE 205
REDMOND WA
98052-3606
US

V. Phone/Fax

Practice location:
  • Phone: 425-836-1800
  • Fax: 425-836-1877
Mailing address:
  • Phone: 425-836-1800
  • Fax: 425-836-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD00042487
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: