Provider Demographics
NPI:1427065697
Name:TRONVIG, WILLIAM JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAMES
Last Name:TRONVIG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1220 BASICH BLVD
Mailing Address - Street 2:SUITE #C
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1034
Mailing Address - Country:US
Mailing Address - Phone:360-533-7388
Mailing Address - Fax:360-533-2529
Practice Address - Street 1:1220 BASICH BLVD
Practice Address - Street 2:SUITE #C
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1034
Practice Address - Country:US
Practice Address - Phone:360-533-7388
Practice Address - Fax:360-533-2529
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA252-01:0000320213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WATR8319OtherREGENCE RIDER NUMBER
WA1078989Medicaid
WA480001662OtherRAILROAD MEDICARE
WA91-1181077OtherFEDERAL TAX ID
WATR8319OtherREGENCE RIDER NUMBER
WA91-1181077OtherFEDERAL TAX ID
WA0292910001Medicare NSC