Provider Demographics
NPI:1790966851
Name:DPMSALTONPRWA LLC
Entity Type:Organization
Organization Name:DPMSALTONPRWA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:SALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-841-3668
Mailing Address - Street 1:PO BOX 50150
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98015-0150
Mailing Address - Country:US
Mailing Address - Phone:425-228-5228
Mailing Address - Fax:425-228-5733
Practice Address - Street 1:11201 88TH AVE E
Practice Address - Street 2:SUITE 210
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3802
Practice Address - Country:US
Practice Address - Phone:253-841-3668
Practice Address - Fax:253-841-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000834213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7141864Medicaid
WA7141864Medicaid
WA6099470002Medicare NSC