Organization
FAMILY FOOT AND ANKLE CARE INCORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON R TIESSEN DPM (PHYSICIAN)
(360) 679-3117
Entity
Organization
Contact information
Practice address
1100 SW BOWMER ST, STE A-103, OAK HARBOR, WA 98277-3119
(360) 679-3117
(360) 679-3118
Mailing address
1100 SW BOWMER ST, STE A-103, OAK HARBOR, WA 98277-3119
(360) 679-3117
(360) 679-3118
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
P000000673
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1119163
—
WA
Enumeration date
03/12/2008
Last updated
07/21/2008
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