Provider Demographics
NPI:1528079217
Name:HUSTRULID, ROBERT IVER (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:IVER
Last Name:HUSTRULID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1215 N MDDONALD RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99216
Mailing Address - Country:US
Mailing Address - Phone:509-924-1950
Mailing Address - Fax:509-921-0017
Practice Address - Street 1:1215 N MDDONALD RD
Practice Address - Street 2:STE 101
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99216
Practice Address - Country:US
Practice Address - Phone:509-924-1950
Practice Address - Fax:509-921-0017
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00012133207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7052905Medicaid
WAA07236Medicare UPIN
WAGAB06613Medicare PIN
WAP00425992Medicare PIN