Provider Demographics
NPI:1902847551
Name:LO, EDDIE P (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:P
Last Name:LO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2302 S UNION AVE STE B18
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1333
Mailing Address - Country:US
Mailing Address - Phone:253-572-4848
Mailing Address - Fax:253-572-1803
Practice Address - Street 1:2302 S UNION AVE STE B18
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1333
Practice Address - Country:US
Practice Address - Phone:253-572-4848
Practice Address - Fax:253-572-1803
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000633213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1106012Medicaid
WA8473167Medicaid
WALO2467OtherREGENCE
WAP00434092OtherMEDICARE RAILROAD
WA215606OtherLABOR AND INDUSTRIES
WA6065600001Medicare NSC
WAG8862902Medicare PIN
WAU72562Medicare UPIN
WA8473167Medicaid