Provider Demographics
NPI:1871955203
Name:ROBERTSON, IRENE (DO)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:SMARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 5299
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0299
Mailing Address - Country:US
Mailing Address - Phone:206-819-7713
Mailing Address - Fax:
Practice Address - Street 1:2420 S UNION AVE STE 300
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1387
Practice Address - Country:US
Practice Address - Phone:253-680-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60963582207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine