MEDICARE: DR. ROBERT H. SMALL M.D.

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	2084P0804X	Child & Adolescent Psychiatry Physician	MD00023949	WA

General Provider Information

NPI Number	:	1215933890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT H. SMALL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1517
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98009-1517
Country	:	US
Telephone Number	:	206-286-4421
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 220TH STREET S.W.
Second Line	:	MAILSTOP 445
City	:	MOUNTLAKE TERRACE
State	:	WA
Zip	:	98043-2124
Country	:	US
Telephone Number	:	425-918-4573
Fax Number	:	425-918-4270

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/20/2007

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