Healthcare Provider Details

I. General information

NPI: 1306904552
Provider Name (Legal Business Name): NATHAN LEE FROST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CTR
TACOMA WA
98431-0001
US

IV. Provider business mailing address

525 FOOTE ST SW
OLYMPIA WA
98502-5429
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3121
  • Fax:
Mailing address:
  • Phone: 708-220-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMD 60143548
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: