Healthcare Provider Details

I. General information

NPI: 1831237312
Provider Name (Legal Business Name): LAWRENCE Z HUPPIN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BROADWAY SUITE 220
SEATTLE WA
98122-5395
US

IV. Provider business mailing address

600 BROADWAY SUITE 220
SEATTLE WA
98122-5395
US

V. Phone/Fax

Practice location:
  • Phone: 206-344-3808
  • Fax: 707-549-5023
Mailing address:
  • Phone: 206-344-3808
  • Fax: 707-549-5023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberP0000435
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: