Provider Demographics
NPI:1396782272
Name:PANKE, ROLF K (DO)
Entity type:Individual
Prefix:
First Name:ROLF
Middle Name:K
Last Name:PANKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 3RD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-9730
Mailing Address - Country:US
Mailing Address - Phone:509-725-7501
Mailing Address - Fax:509-725-7504
Practice Address - Street 1:100 3RD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DAVENPORT
Practice Address - State:WA
Practice Address - Zip Code:99122-9730
Practice Address - Country:US
Practice Address - Phone:509-725-7501
Practice Address - Fax:509-725-7504
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001672207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7101132Medicaid
WA7117450Medicaid
WA8256844Medicaid
WACJ6525OtherMEDICARE RAILROAD
WA080176450OtherMEDICARE RAILROAD
WA154641OtherDEPT. OF L & I
WA7101132Medicaid
H21125Medicare UPIN
AB25319Medicare ID - Type Unspecified
WA7117450Medicaid
WAGAB16799Medicare PIN
WAGAB25319Medicare PIN