Healthcare Provider Details

I. General information

NPI: 1104814227
Provider Name (Legal Business Name): ROBERT F SESTERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S MCCLELLAN ST #116
SPOKANE WA
99204-2457
US

IV. Provider business mailing address

820 S MCCLELLAN ST #116
SPOKANE WA
99204-2457
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-4211
  • Fax: 509-838-6432
Mailing address:
  • Phone: 509-838-4211
  • Fax: 509-838-4211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00014617
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: