Basic Information
| Provider Information | |||||||||
| NPI: | 1306866652 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIEDBALSKI | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 LAKE LUCIEN DR | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | MAITLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327517233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078752080 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10900 NE 4TH ST | ||||||||
| Address2: | STE 1650 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980045873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254546295 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OP00001760 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.