Healthcare Provider Details

I. General information

NPI: 1013924836
Provider Name (Legal Business Name): ROBERT MCBRIDE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 S 19TH ST STE 202
TACOMA WA
98405-1462
US

IV. Provider business mailing address

4050 SO 19TH STREET SUITE 202 MS: 737-2-PHYS
TACOMA WA
98405
US

V. Phone/Fax

Practice location:
  • Phone: 253-565-3355
  • Fax: 253-564-6744
Mailing address:
  • Phone: 253-565-3355
  • Fax: 253-564-6744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO00000249
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO00000249
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: