Provider Demographics
NPI:1972812196
Name:MARK W. SHEAFOR, DPM, PS, INC
Entity Type:Organization
Organization Name:MARK W. SHEAFOR, DPM, PS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WHITMAN
Authorized Official - Last Name:SHEAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:360-647-0557
Mailing Address - Street 1:3120 SQUALICUM PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1934
Mailing Address - Country:US
Mailing Address - Phone:360-647-0557
Mailing Address - Fax:360-733-2892
Practice Address - Street 1:3120 SQUALICUM PKWY STE 2
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1934
Practice Address - Country:US
Practice Address - Phone:360-647-0557
Practice Address - Fax:360-733-2892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60134920213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1346561446AAOtherESSENCE
WA1054194OtherDSHS
WADQ7833OtherRAILROAD MEDICARE
WA1054194OtherDSHS
WAG8894823Medicare PIN