Evergreen Foot & Ankle Specialists PLLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

PO00000682 Issued in WA

Legal business name

EVERGREEN FOOT & ANKLE SPECIALISTS PLLC

Practice address

2415 SE 165TH Ave Ste 104
Vancouver, WA 98683-4324

Phone

(360) 694-3668

Fax

(360) 882-3566

NPI assigned

Jul 14, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kurt W Davis, DPM

Title

Manager

Phone

(360) 694-3668

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284422400000",
    "number": "1386956704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 SE 165TH AVE STE 104",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986834324",
            "telephone_number": "360-694-3668",
            "fax_number": "360-882-3566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 SE 165TH AVE STE 104",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986834324",
            "telephone_number": "360-694-3668",
            "fax_number": "360-882-3566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN FOOT & ANKLE SPECIALISTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-14",
        "last_updated": "2010-09-14",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KURT",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "360-694-3668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "WA",
            "license": "PO00000682",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "WA",
            "license": "PO000000682",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Foot & Ankle Surgery Podiatrist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Foot & Ankle Surgery Podiatrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.