Healthcare Provider Details

I. General information

NPI: 1023275625
Provider Name (Legal Business Name): LEE ANGUS ROBERTSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 AURORA AVE N SUITE 100
SEATTLE WA
98103-7379
US

IV. Provider business mailing address

1308 W WHEELER ST
SEATTLE WA
98119-2423
US

V. Phone/Fax

Practice location:
  • Phone: 510-390-4492
  • Fax:
Mailing address:
  • Phone: 510-390-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOP60238547
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: