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General NPI Number Information
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NPI Number | 1538144753
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Entity Type | Organization
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Legal Business Name | INLAND NORTHWEST FOOT AND ANKLE PC
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 1590 E POLSTON AVE STE A
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City | POST FALLS
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State | ID
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Zip | 83854-5218
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Country | US
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Telephone | 208-777-9794
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Fax | 208-777-9523
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Provider Business Mailing Address
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Address Line | 1590 E POLSTON AVE STE A
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City | POST FALLS
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State | ID
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Zip | 83854-5218
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Country | US
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Telephone | 208-777-9794
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Fax | 208-777-9523
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Authorized Official
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Title or Position | OWNER
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Name | BRYAN T THOMPSON
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Credential | DPM
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Telephone | 208-777-9794
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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 | P173
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License Number State | ID
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