=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407426497
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIGFOOT PODIATRY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2021
-----------------------------------------------------
Last Update Date | 08/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9927 MICKELBERRY RD NW STE 101
-----------------------------------------------------
City | SILVERDALE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98383-7861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-616-9563
-----------------------------------------------------
Fax | 360-850-1423
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9927 MICKELBERRY RD NW STE 101
-----------------------------------------------------
City | SILVERDALE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98383-7861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-616-9563
-----------------------------------------------------
Fax | 360-850-1423
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | DR. ALI CROSS
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 360-990-0716
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------