Provider Demographics
NPI:1700283793
Name:WEST CAMPUS FOOT & ANKLE CLINIC INC
Entity Type:Organization
Organization Name:WEST CAMPUS FOOT & ANKLE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:253-838-8377
Mailing Address - Street 1:33801 1ST WAY S
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4546
Mailing Address - Country:US
Mailing Address - Phone:253-838-8377
Mailing Address - Fax:253-838-9474
Practice Address - Street 1:33801 1ST WAY S
Practice Address - Street 2:SUITE 105
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4546
Practice Address - Country:US
Practice Address - Phone:253-838-8377
Practice Address - Fax:253-838-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000669213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1881686731OtherINDIVIDUAL NPI