Healthcare Provider Details

I. General information

NPI: 1912935719
Provider Name (Legal Business Name): ROBERT T. TRUCKNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

11611 S BALTIMORE RD
SPOKANE WA
99223-9553
US

V. Phone/Fax

Practice location:
  • Phone: 919-357-7654
  • Fax:
Mailing address:
  • Phone: 919-357-7654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2005-01369
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number2005-01369
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: