Provider Demographics
NPI:1104085661
Name:ROBERT L. WHITSON
Entity type:Organization
Organization Name:ROBERT L. WHITSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-946-5233
Mailing Address - Street 1:846 STEVENS DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3507
Mailing Address - Country:US
Mailing Address - Phone:509-946-5233
Mailing Address - Fax:509-946-5326
Practice Address - Street 1:846 STEVENS DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3507
Practice Address - Country:US
Practice Address - Phone:509-946-5233
Practice Address - Fax:509-946-5326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA51646OtherL&I
WA1067941Medicaid
WAD69035Medicare UPIN