Provider Demographics
NPI:1902309313
Name:LAKE WASHINGTON PRIMARY CARE LLC
Entity Type:Organization
Organization Name:LAKE WASHINGTON PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-898-2416
Mailing Address - Street 1:8015 SE 28TH ST STE 310
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2910
Mailing Address - Country:US
Mailing Address - Phone:206-898-2416
Mailing Address - Fax:877-771-1013
Practice Address - Street 1:8015 SE 28TH ST STE 310
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2910
Practice Address - Country:US
Practice Address - Phone:206-898-2416
Practice Address - Fax:877-771-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA33004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty