Healthcare Provider Details

I. General information

NPI: 1083042089
Provider Name (Legal Business Name): DYNAMIC FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8716 E MILL PLAIN BLVD
VANCOUVER WA
98664-2531
US

IV. Provider business mailing address

17241 SW GALEWOOD DR
SHERWOOD OR
97140-7911
US

V. Phone/Fax

Practice location:
  • Phone: 503-530-9245
  • Fax:
Mailing address:
  • Phone: 503-530-9245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO60127687
License Number StateWA

VIII. Authorized Official

Name: DR. SCOTT KENNETH RASMUSSEN
Title or Position: OWNER
Credential: DPM
Phone: 503-530-9245