Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | OI00000176 | WA |
N | 222Z00000X | Podiatrist | OI00000176 | WA |
Y | 224P00000X | Prosthetist | PS00000283 | WA |
NPI | 1285695007 |
---|---|
Provider Name | Dale E Anderson |
First Address | Olympia, WA 98507-1994 |
Second Address | Olympia, WA 98502-5700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 04/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3580WE | BLUESHIELD (01) | WA |
9051483 | (05) | WA |