Basic Information
| Provider Information | |||||||||
| NPI: | 1225079585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARGULIES | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | ALLAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 N 4TH AVE STE 600 | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993015257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094168849 | ||||||||
| FaxNumber: | 5095423059 | ||||||||
| Practice Location | |||||||||
| Address1: | 5304 ROAD 68 | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993018078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0954393005 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 08/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD00032304 | WA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3076MA | 01 | WA | BSWA | OTHER | 8168247 | 05 | WA | MEDICAID | 0202698 | 01 | WA | LIWA | OTHER |