Provider Demographics
NPI:1427120427
Name:BACERDO, FRANCISCO M (DPM)
Entity type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:M
Last Name:BACERDO
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:PO BOX 1746
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98046-1746
Mailing Address - Country:US
Mailing Address - Phone:425-778-9115
Mailing Address - Fax:425-771-9179
Practice Address - Street 1:20006 CEDAR VALLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6334
Practice Address - Country:US
Practice Address - Phone:425-778-9115
Practice Address - Fax:425-771-9179
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO 00000526213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1095546Medicaid
WAU48195Medicare UPIN
WA480017858Medicare ID - Type UnspecifiedRAIL ROAD MEDICARE
WAGAB10165Medicare PIN
WA1095546Medicaid