1730260241 NPI number — PAUL W AUFDERHEIDE DPM

Table of content: PAUL W AUFDERHEIDE DPM (NPI 1730260241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730260241 NPI number — PAUL W AUFDERHEIDE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUFDERHEIDE
Provider First Name:
PAUL
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730260241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10049 KITSAP MALL BLVD NW
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
SILVERDALE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98383-8903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-698-2505
Provider Business Mailing Address Fax Number:
360-698-2514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10049 KITSAP MALL BLVD NW
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
SILVERDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98383-8903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-698-2505
Provider Business Practice Location Address Fax Number:
360-698-2514
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  P0000000335 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1185503 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AU0282 . This is a "REGENCE RIDER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 480002668 . This is a "MEDICARE RR" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1801065040 . This is a "GROUP NPI EFFECTIVE 01012008" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0022837 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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