MEDICARE: ELAINE BOLLING ROE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD00041977	WA

General Provider Information

NPI Number	:	1073506804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE BOLLING ROE MD

Provider Business Mailing Address
First Line	:	403 E MEEKER ST
Second Line	:	STE 300
City	:	KENT
State	:	WA
Zip	:	98030-5904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 E MEEKER ST
Second Line	:	STE 200
City	:	KENT
State	:	WA
Zip	:	98030-5904
Country	:	US
Telephone Number	:	253-852-2866
Fax Number	:	253-852-3102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	07/08/2007

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Directions to “ ELAINE BOLLING ROE MD” Practice Location

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