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General NPI Number Information
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NPI Number | 1861010548
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Entity Type | Organization
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Legal Business Name | PENINSULA FOOT AND ANKLE CLINIC PLLC
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 630 E 8TH ST
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City | PORT ANGELES
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State | WA
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Zip | 98362-6224
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Country | US
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Telephone | 425-286-5686
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Fax |
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Provider Business Mailing Address
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Address Line | 1310 ROOK DR
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City | PORT ANGELES
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State | WA
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Zip | 98362-2777
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Country | US
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Telephone | 425-286-5686
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | AUSTIN FRISWOLD
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Credential | DPM
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Telephone | 425-286-5686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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