Provider Demographics
NPI:1568753499
Name:ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Entity Type:Organization
Organization Name:ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Other - Org Name:ANKLE & FOOT SPECIALIST OF ISSAQUAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:206-313-4890
Mailing Address - Street 1:2728 E MAIN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3198
Mailing Address - Country:US
Mailing Address - Phone:253-841-2006
Mailing Address - Fax:253-840-6691
Practice Address - Street 1:751 NE BLAKELY DR FL 4
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6201
Practice Address - Country:US
Practice Address - Phone:425-394-0200
Practice Address - Fax:253-631-0596
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO 00000712213E00000X, 213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8906903Medicare PIN