# DR. ROBERT ROSCOE NOONEY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1558389544
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | OP00001277 | WA | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | OPO00001277 | WA | — |

## Other

- **Enumeration date:** 07/17/2006
- **Last updated:** 12/12/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1083021 | — | WA |
| 01 | — | 262210405 | TAX ID | WA |
| 01 | — | 424713001 | GROUP HEALTH | WA |
| 01 | — | 48546 | L&I WORKERS COMP | WA |
| 01 | — | 7492 | QUALMED | WA |
| 01 | — | NO1029 | BLUE CROSS BLUE SHIELD | WA |