Basic Information
| Provider Information | |||||||||
| NPI: | 1417068446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HURLOW | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1344 WINTERGREEN LN NE UNIT 100 | ||||||||
| Address2: | |||||||||
| City: | BAINBRIDGE ISLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981105147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062010488 | ||||||||
| FaxNumber: | 2062010490 | ||||||||
| Practice Location | |||||||||
| Address1: | 1344 WINTERGREEN LN NE UNIT 100 | ||||||||
| Address2: | |||||||||
| City: | BAINBRIDGE ISLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981105147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062010488 | ||||||||
| FaxNumber: | 2062010490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 10/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00021882 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | AH1973393 | 01 | DEA | OTHER | 1009870 | 05 | WA | MEDICAID | 6273HU | 01 | REGENCE | OTHER | 225462 | 01 | WA | LABOR & INDUSTRIES | OTHER | P00729671 | 01 | RAILROAD MEDICARE | OTHER | AETNA | 01 | 4136581 | OTHER |