Healthcare Provider Details

I. General information

NPI: 1407426497
Provider Name (Legal Business Name): BIGFOOT PODIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9927 MICKELBERRY RD NW STE 101
SILVERDALE WA
98383-7861
US

IV. Provider business mailing address

9927 MICKELBERRY RD NW STE 101
SILVERDALE WA
98383-7861
US

V. Phone/Fax

Practice location:
  • Phone: 360-616-9563
  • Fax: 360-850-1423
Mailing address:
  • Phone: 360-616-9563
  • Fax: 360-850-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALI CROSS
Title or Position: CO-OWNER
Credential: DPM
Phone: 360-990-0716