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General NPI Number Information
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NPI Number | 1639771348
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Entity Type | Organization
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Legal Business Name | LIBERTY ORTHOPEDICS PS
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 20696 BOND RD NE STE 205
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City | POULSBO
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State | WA
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Zip | 98370-9025
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Country | US
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Telephone | 360-930-0222
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Fax | 360-210-1429
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Provider Business Mailing Address
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Address Line | 20696 BOND RD NE STE 205
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City | POULSBO
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State | WA
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Zip | 98370-9025
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Country | US
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Telephone | 360-930-0222
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Fax | 360-210-1429
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Authorized Official
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Title or Position | PRESIDENT/PROVIDER
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Name | JOHN REID WEST
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Credential | MD
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Telephone | 360-801-7966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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