Provider Demographics
NPI:1750660361
Name:HODGKIN, ROBERT JOHN (LMP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:HODGKIN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:HODGKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:23309 3RD PL W
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8609
Mailing Address - Country:US
Mailing Address - Phone:425-481-4525
Mailing Address - Fax:
Practice Address - Street 1:17220 127TH PL NE
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-7965
Practice Address - Country:US
Practice Address - Phone:425-949-2968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00001636174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0171143OtherWASHINGTON STATE LABOR AND INDUSTRIES