Healthcare Provider Details

I. General information

NPI: 1609997766
Provider Name (Legal Business Name): ALYSON GALE ROBY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 KLA-OOK-WAH DR
TAHOLAH WA
98587
US

IV. Provider business mailing address

10819 E RINEAR RD
VALLEYFORD WA
99036-9749
US

V. Phone/Fax

Practice location:
  • Phone: 360-276-4405
  • Fax:
Mailing address:
  • Phone: 509-921-9199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00038362
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: