Provider Demographics
NPI:1992744031
Name:CAULKINS, ROBERT LEE (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:CAULKINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2601 CHERRY AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4203
Mailing Address - Country:US
Mailing Address - Phone:360-373-9191
Mailing Address - Fax:360-373-8682
Practice Address - Street 1:2601 CHERRY AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4203
Practice Address - Country:US
Practice Address - Phone:360-373-9191
Practice Address - Fax:360-373-8682
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001096207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1017045Medicaid
WA1017045Medicaid