Basic Information
| Provider Information | |||||||||
| NPI: | 1649453739 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARWICK | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 30809 1ST AVE S | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980034074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538392030 | ||||||||
| FaxNumber: | 2538391071 | ||||||||
| Practice Location | |||||||||
| Address1: | 30809 1ST AVE S | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980034074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538392030 | ||||||||
| FaxNumber: | 2538391071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2007 | ||||||||
| LastUpdateDate: | 10/17/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00014587 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0264294 | 01 | WA | STATE L&I | OTHER | 0264298 | 01 | WA | STATE L&I | OTHER | 0264305 | 01 | WA | STATE L&I | OTHER | 0264301 | 01 | WA | STATE L&I | OTHER | 0264295 | 01 | WA | STATE L&I | OTHER | 0264297 | 01 | WA | STATE L&I | OTHER | 0264304 | 01 | WA | STATE L&I | OTHER | 0291699 | 01 | WA | STATE L&I | OTHER | 0298551 | 01 | WA | STATE L&I | OTHER | 8946021 | 01 | WA | STATE CRIME VICTIMS | OTHER | 0227277 | 01 | WA | STATE L&I | OTHER | 0264300 | 01 | WA | STATE L&I | OTHER | 0264296 | 01 | WA | STATE L&I | OTHER | 0264299 | 01 | WA | STATE L&I | OTHER | 0264303 | 01 | WA | STATE L&I | OTHER | 8500720 | 05 | WA | MEDICAID |