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General NPI Number Information
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NPI Number | 1265470678
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Entity Type | Organization
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Legal Business Name | BROADWAY FOOT & ANKLE PS
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 6625 W CREST VIEW LOOP SE
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City | SNOQUALMIE
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State | WA
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Zip | 98065-8912
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Country | US
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Telephone | 425-396-5424
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 24963
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City | SEATTLE
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State | WA
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Zip | 98124-0963
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Country | US
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Telephone | 206-320-4476
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Fax | 206-320-5340
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. BARRY L LICHTER
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Credential | DPM
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Telephone | 206-386-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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