Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO60757497 | WA |
NPI | 1073931275 |
---|---|
Provider Name | Dr. Edward Chesnutis III |
First Address | Everett, WA 98208-4252 |
Second Address | Denver, CO 80218-1243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2014 |
Last Update Date | 19/06/2017 |