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General NPI Number Information
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NPI Number | 1700283793
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Entity Type | Organization
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Legal Business Name | WEST CAMPUS FOOT & ANKLE CLINIC INC
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 33801 1ST WAY S SUITE 105
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City | FEDERAL WAY
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State | WA
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Zip | 98003-4546
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Country | US
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Telephone | 253-838-8377
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Fax | 253-838-9474
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Provider Business Mailing Address
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Address Line | 33801 1ST WAY S SUITE 105
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City | FEDERAL WAY
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State | WA
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Zip | 98003-4546
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Country | US
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Telephone | 253-838-8377
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Fax | 253-838-9474
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MICHAEL J. FRAZIER
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Credential | DPM
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Telephone | 253-838-8377
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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 | PO00000669
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License Number State | WA
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