Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD00011384 | WA |
NPI | 1154380194 |
---|---|
Provider Name | Dr. Robert William Gaubatz |
First Address | Bellingham, WA 98227-5096 |
Second Address | Bellingham, WA 98225-1945 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 30/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1154380194 | (05) | WA |
5052GA | REGENCE (01) | WA |
7758113 | AETNA (01) | WA |
A08230 | (02) | WA |