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Organization
EVERGREEN FOOT & ANKLE SPECIALISTS PLLC
Active
Organization
EVERGREEN FOOT & ANKLE SPECIALISTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KURT W DAVIS DPM (MANAGER)
(360) 694-3668
Entity
Organization
Contact information
Practice address
2415 SE 165TH AVE STE 104, VANCOUVER, WA 98683-4324
(360) 694-3668
(360) 882-3566
Mailing address
2415 SE 165TH AVE STE 104, VANCOUVER, WA 98683-4324
(360) 694-3668
(360) 882-3566
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO00000682
WA
332BC3200X
Customized Equipment (DME)
PO000000682
WA
Other
Enumeration date
07/14/2010
Last updated
09/14/2010
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