Provider Demographics
NPI:1649352527
Name:LO, ANTHONY (DPM)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:LO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 MADISON ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:206-264-8100
Mailing Address - Fax:
Practice Address - Street 1:515 MINOR AVE.
Practice Address - Street 2:SUITE 240
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2133
Practice Address - Country:US
Practice Address - Phone:206-386-9668
Practice Address - Fax:206-386-9544
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIP206213E00000X
WAP000000325213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA225904OtherLABOR & INDUSTRY
WAP00461226OtherPALMETTO / RR MEDICARE
WA1001072Medicaid
WA5891740001OtherDME
WA6815LOOtherREGENCE
WA1001072Medicaid
WA5891740001OtherDME