Healthcare Provider Details

I. General information

NPI: 1528045705
Provider Name (Legal Business Name): BRADLEY ROTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH AVE STE 100
SEATTLE WA
98122-5636
US

IV. Provider business mailing address

13320 108TH AVE SW
VASHON WA
98070-3320
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-2484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00026420
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: