Healthcare Provider Details

I. General information

NPI: 1881923050
Provider Name (Legal Business Name): HARBOR FOOT & ANKLE CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 BASICH BLVD STE C
ABERDEEN WA
98520-1053
US

IV. Provider business mailing address

1220 BASICH BLVD STE C
ABERDEEN WA
98520-1053
US

V. Phone/Fax

Practice location:
  • Phone: 360-533-7388
  • Fax: 360-533-2529
Mailing address:
  • Phone: 360-533-7388
  • Fax: 360-533-2529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 00000320
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM J TRONVIG
Title or Position: PODIATRIST
Credential: DPM
Phone: 360-533-7388