Provider Demographics
NPI:1497701742
Name:HAWLEY, FRED J JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:J
Last Name:HAWLEY
Suffix:JR
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 1:17432 SMOKEY POINT BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-6363
Mailing Address - Country:US
Mailing Address - Phone:360-653-2326
Mailing Address - Fax:360-658-8944
Practice Address - Street 1:17432 SMOKEY POINT BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-6363
Practice Address - Country:US
Practice Address - Phone:360-653-2326
Practice Address - Fax:360-658-8944
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO676213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8023657Medicaid
AB26759Medicare ID - Type Unspecified
WA4457470001Medicare NSC
U83570Medicare UPIN