Provider Demographics
NPI:1932280443
Name:PAUL W AUFDERHEIDE DPM
Entity Type:Organization
Organization Name:PAUL W AUFDERHEIDE DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:AUFDERHEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:360-698-2505
Mailing Address - Street 1:9633 LEVIN RD NW
Mailing Address - Street 2:PAUL W AUFDERHEIDE SUITE 202
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8131
Mailing Address - Country:US
Mailing Address - Phone:360-698-2505
Mailing Address - Fax:360-698-2514
Practice Address - Street 1:9633 LEVIN RD NW
Practice Address - Street 2:PAUL W AUFDERHEIDE SUITE 202
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383
Practice Address - Country:US
Practice Address - Phone:360-698-2505
Practice Address - Fax:360-698-2514
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAUL W AUFDERHEIDE DPM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-18
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000335213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7125180Medicaid
WA0188447OtherL&I
WA0188447OtherL&I
WA7125180Medicaid