Provider Demographics
NPI:1730260241
Name:AUFDERHEIDE, PAUL W (DPM)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:AUFDERHEIDE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10049 KITSAP MALL BLVD NW
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8903
Mailing Address - Country:US
Mailing Address - Phone:360-698-2505
Mailing Address - Fax:360-698-2514
Practice Address - Street 1:10049 KITSAP MALL BLVD NW
Practice Address - Street 2:SUITE 109
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8903
Practice Address - Country:US
Practice Address - Phone:360-698-2505
Practice Address - Fax:360-698-2514
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP0000000335213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1185503Medicaid
WAAU0282OtherREGENCE RIDER
WA480002668OtherMEDICARE RR
WA1801065040OtherGROUP NPI EFFECTIVE 01012008
WA0022837OtherL&I
WA1801065040OtherGROUP NPI EFFECTIVE 01012008
WA480002668OtherMEDICARE RR
WAT02140Medicare UPIN