Provider Demographics
NPI:1265470678
Name:BROADWAY FOOT & ANKLE PS
Entity Type:Organization
Organization Name:BROADWAY FOOT & ANKLE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:206-386-2800
Mailing Address - Street 1:PO BOX 24963
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0963
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-320-5340
Practice Address - Street 1:6625 W CREST VIEW LOOP SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-8912
Practice Address - Country:US
Practice Address - Phone:425-396-5424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA193384900OtherWASHINGTON LABOR & INDUSTRY
WA193384900OtherWASHINGTON LABOR & INDUSTRY