Provider Demographics
NPI:1497151344
Name:BETSY FLODSTROM MD PLLC
Entity Type:Organization
Organization Name:BETSY FLODSTROM MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:360-452-2022
Mailing Address - Street 1:901 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7848
Mailing Address - Country:US
Mailing Address - Phone:360-452-2022
Mailing Address - Fax:360-457-1686
Practice Address - Street 1:901 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7848
Practice Address - Country:US
Practice Address - Phone:360-452-2022
Practice Address - Fax:360-457-1686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8936177Medicare UPIN
WAG8936177Medicare PIN