Individual
ROBERT ALAN WALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, FACC
Contact information
Practice address
2315 8TH ST GRADE, LEWISTON, ID 83501-7301
(509) 455-8820
(509) 227-7070
Mailing address
PO BOX 331, LIBERTY LAKE, WA 99019-0331
(509) 747-2455
(509) 227-7070
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
M-8366
ID
207RC0000X
Cardiovascular Disease Physician
MD00040353
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060064955
RRB
WA
05
—
806097900
—
ID
05
—
8283913
—
WA
Enumeration date
07/27/2006
Last updated
03/01/2021
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