Provider Demographics
NPI:1154380194
Name:GAUBATZ, ROBERT WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:GAUBATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-715-4186
Mailing Address - Fax:360-715-4143
Practice Address - Street 1:3015 SQUALICUM PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1945
Practice Address - Country:US
Practice Address - Phone:360-715-4186
Practice Address - Fax:360-715-4143
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00011384207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1154380194Medicaid
WA5052GAOtherREGENCE
WA7758113OtherAETNA
WAG8851353Medicare PIN
WAA08230Medicare UPIN