Provider Demographics
NPI:1154479327
Name:WASHINGTON FOOT AND ANKLE SPORTS MEDICINE PLLC
Entity Type:Organization
Organization Name:WASHINGTON FOOT AND ANKLE SPORTS MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:425-899-3234
Mailing Address - Street 1:12707 120TH AVE NE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7500
Mailing Address - Country:US
Mailing Address - Phone:425-899-3234
Mailing Address - Fax:425-899-3235
Practice Address - Street 1:12911 120TH AVE NE STE C50
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3080
Practice Address - Country:US
Practice Address - Phone:425-899-3234
Practice Address - Fax:425-899-3235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO710213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1982683322OtherPRACTITIONER NPI
WA1144210287OtherPRACTITIONER NPI
WAU97135Medicare UPIN
WAU85646Medicare UPIN