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General NPI Number Information
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NPI Number | 1881923050
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Entity Type | Organization
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Legal Business Name | HARBOR FOOT & ANKLE CLINIC PLLC
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 1220 BASICH BLVD STE C
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City | ABERDEEN
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State | WA
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Zip | 98520-1053
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Country | US
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Telephone | 360-533-7388
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Fax | 360-533-2529
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Provider Business Mailing Address
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Address Line | 1220 BASICH BLVD STE C
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City | ABERDEEN
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State | WA
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Zip | 98520-1053
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Country | US
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Telephone | 360-533-7388
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Fax | 360-533-2529
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. WILLIAM J TRONVIG
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Credential | DPM
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Telephone | 360-533-7388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO 00000320
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License Number State | WA
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