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General NPI Number Information
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NPI Number | 1063475291
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Entity Type | Individual
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Provider Name | ROBERT GEORGE TEARSE M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 09/08/2018
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Provider Practice Location Address
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Address Line | 4471 NOB HILL LN
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City | FREELAND
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State | WA
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Zip | 98249
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Country | US
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Telephone | 541-225-7476
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1228
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City | FREELAND
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State | WA
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Zip | 98249-1228
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Country | US
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Telephone | 541-225-7476
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD13116
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number | 60656697
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License Number State | WA
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