Provider Demographics
NPI:1730181769
Name:WARK, ROBERT S (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:WARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:500 LILLY RD NE
Mailing Address - Street 2:STE 100
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5195
Mailing Address - Country:US
Mailing Address - Phone:360-413-8525
Mailing Address - Fax:360-413-8876
Practice Address - Street 1:500 LILLY RD NE
Practice Address - Street 2:STE 100
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5195
Practice Address - Country:US
Practice Address - Phone:360-413-8525
Practice Address - Fax:360-413-8876
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00023085207RC0001X
WA23085207RC0001X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8118358Medicaid
WA8118358Medicaid
E53879Medicare UPIN