Provider Demographics
NPI:1699791574
Name:NAGATA, ROBB K (MD)
Entity type:Individual
Prefix:DR
First Name:ROBB
Middle Name:K
Last Name:NAGATA
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 1:6110 62ND AVENUE CT NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-7483
Mailing Address - Country:US
Mailing Address - Phone:541-554-0126
Mailing Address - Fax:
Practice Address - Street 1:400 E PIONEER STE 101
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3256
Practice Address - Country:US
Practice Address - Phone:253-445-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD14600207L00000X
ORMD25021207L00000X
WAMD00048911207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8519274Medicaid
ORP00145889OtherRAILROAD MEDICARE
ORA057OtherTRICARE
OR022482Medicaid
ORP00655519OtherRAILROAD MEDICARE
OR118833Medicare ID - Type Unspecified
WA8519274Medicaid
ORI04809Medicare UPIN