Basic Information
| Provider Information | |||||||||
| NPI: | 1396820536 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARLEY | ||||||||
| FirstName: | CHAD | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11307 BRIDGEPORT WAY SW | ||||||||
| Address2: | STE 220A | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984993024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539852733 | ||||||||
| FaxNumber: | 2539853868 | ||||||||
| Practice Location | |||||||||
| Address1: | 11307 BRIDGEPORT WAY SW | ||||||||
| Address2: | STE 220A | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984993024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539852733 | ||||||||
| FaxNumber: | 2539853868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 11/10/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | PO00000731 | WA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00345477 | 01 | WA | RAILROAD | OTHER | 0219604 | 01 | WA | L & I | OTHER | 203641 | 01 | WA | L & I | OTHER | 8940615 | 01 | WA | CRIME VICTIMS | OTHER | 8944020 | 01 | WA | CRIME VICTIMS | OTHER | 8441636 | 05 | WA | MEDICAID |