Provider Demographics
NPI:1871571174
Name:WASSON, ROBERT DOANE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DOANE
Last Name:WASSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 HIGHWAY 71 NE
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-9504
Mailing Address - Country:US
Mailing Address - Phone:320-231-5100
Mailing Address - Fax:320-231-5329
Practice Address - Street 1:1550 HIGHWAY 71 NE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-9504
Practice Address - Country:US
Practice Address - Phone:320-231-5100
Practice Address - Fax:320-231-5329
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN163112083A0100X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN206G0WAOtherBC/BS MPIN
MN206G0WAOtherBC/BS MPIN