=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073911046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEATTLE FOOT AND ANKLE WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2014
-----------------------------------------------------
Last Update Date | 08/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3225 CALIFORNIA AVE SW
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98116-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-607-6709
-----------------------------------------------------
Fax | 206-508-9090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3225 CALIFORNIA AVE SW
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98116-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-607-6709
-----------------------------------------------------
Fax | 206-508-9090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.E.O.
-----------------------------------------------------
Name | DR. PAUL SANN
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 206-962-9229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | PO60482833
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------