Provider Demographics
NPI:1104985951
Name:COLLANTES, ROBERTO CARLOS BARCELONA (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO CARLOS
Middle Name:BARCELONA
Last Name:COLLANTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17209 REDMOND WAY
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4404
Mailing Address - Country:US
Mailing Address - Phone:425-635-6400
Mailing Address - Fax:
Practice Address - Street 1:17209 REDMOND WAY
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4404
Practice Address - Country:US
Practice Address - Phone:425-635-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60385633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1104985951Medicaid
IL1104985951Medicaid