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General NPI Number Information
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NPI Number | 1295760122
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Entity Type | Organization
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Legal Business Name | BATTLE GROUND FOOT AND ANKLE
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 1710 W MAIN ST STE 221
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City | BATTLE GROUND
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State | WA
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Zip | 98604-4317
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Country | US
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Telephone | 360-687-3668
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 W MAIN ST STE 221
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City | BATTLE GROUND
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State | WA
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Zip | 98604-4317
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Country | US
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Telephone | 360-687-3668
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN HAYES
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Credential | DPM
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Telephone | 360-687-3668
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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 | PO00000795
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License Number State | WA
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