Provider Demographics
NPI:1891975181
Name:BRUCE A ROLFE, MD
Entity type:Organization
Organization Name:BRUCE A ROLFE, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-899-6060
Mailing Address - Street 1:12303 NE 130TH LN STE 220
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3060
Mailing Address - Country:US
Mailing Address - Phone:425-899-6060
Mailing Address - Fax:425-899-6078
Practice Address - Street 1:12303 NE 130TH LN STE 220
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3060
Practice Address - Country:US
Practice Address - Phone:425-899-6060
Practice Address - Fax:425-899-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1231220001Medicare NSC
WAGAB 04993Medicare PIN