| NPI | 1679979769 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA EBERHARD Credentialing Specialist 360-706-2767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2021-05-20 |