Provider Demographics
NPI:1477574861
Name:HORSMAN, RICHARD EDWARD (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDWARD
Last Name:HORSMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 ENSIGN RD NE
Mailing Address - Street 2:SUITE L
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5065
Mailing Address - Country:US
Mailing Address - Phone:360-456-3171
Mailing Address - Fax:360-456-2597
Practice Address - Street 1:3525 ENSIGN RD NE
Practice Address - Street 2:SUITE L
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5065
Practice Address - Country:US
Practice Address - Phone:360-456-3171
Practice Address - Fax:360-456-2597
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO 00000248213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WATO0241OtherREGENCE BLUE SHIELD
WA16307OtherDEPT OF LABOR & INDUSTRIE
WA0206100001OtherDMERC
WA1011626Medicaid
WA480006043OtherRR MEDICARE
WAAH8381206OtherDEA
WA0206100001Medicare NSC
WAG8803515Medicare PIN
WA16307OtherDEPT OF LABOR & INDUSTRIE