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General NPI Number Information
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NPI Number | 1073886479
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Entity Type | Organization
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Legal Business Name | ISSAQUAH FOOT & ANKLE SPECIALISTS, P.L.L.C.
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 01/05/2015
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Provider Practice Location Address
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Address Line | 450 NW GILMAN BLVD SUITE 303
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City | ISSAQUAH
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State | WA
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Zip | 98027-2483
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Country | US
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Telephone | 425-391-8666
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Fax | 425-392-6433
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Provider Business Mailing Address
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Address Line | 450 NW GILMAN BLVD SUITE 303
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City | ISSAQUAH
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State | WA
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Zip | 98027-2483
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Country | US
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Telephone | 425-391-8666
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Fax | 425-392-6433
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY YOUNG
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Credential | DPM
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Telephone | 425-391-8666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 601627348
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License Number State | WA
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